We practice in an era of outcome based medicine. It’s not enough anymore, at least when it comes to things like blood pressure and blood sugar, just to treat the numbers (cosmetic treatment). Why, then, in everyday practice, don’t we apply the same rigorous skepticism to the problem of fever?
A recent study in Critical Care looked at the question. Lowering of body temperature was not associated with improved outcomes and in some patients was harmful.
Don’t forget the exceptions, e.g. the better brain outcomes in cardiac arrest and stroke patients, and, of course, treatment of heat stroke and the other hyperthermia syndromes.
2 comments:
This is a great issue in that I completely agree with you on this but haven't had any practical success with it.
The best reason to treat: it avoids a phone call. Every time I get a call for Tylenol for a fever I ask, "Is the patient complaining of fever or feeling bad because of it?" and 99 times out of 100 the answer is no. Most of the time we write PRN Tylenol just to avoid this conversation. I've tried in the past writing things like "PRN symptomatic fever", but I'm not sure what the effectiveness of that is.
Dr. RW - I couldn't agree with you more. I can't tell you how many times I've had to ask a nurse at 2AM why she wants to give her patient (with otherwise normal vital signs) who just had his appendix out 4 hours ago a dose of acetaminophen. If it's just to make the number look better and to make the NURSE feel better, I won't do it. I'd rather get 2 or 3 more phone calls overnight than give unnecessary medicine, especially one as potentially dangerous as acetaminophen.
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