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Treating fever does not affect outcomes
Clinical Question
Does treating fever in adults affect mortality, adverse effects, or quality of life?
Bottom line
Treating patients to reduce their symptomatic fever does not affect mortality or serious adverse events and may not affect the patients' quality of life. The physiologic argument can be made that fever is either (1) a boon that puts the immune system in hyperdrive, or (2) a modifiable affliction that might tip the scales for vulnerable and critically ill patients. Neither concept has much empiric support. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Inpatient (any location)
Synopsis
These authors searched "all relevant databases" (their words) to identify randomized trials that compared the treatment of fever due to any cause with no treatment. They included 42 studies of a variety of antipyretics and physical cooling methods in critically ill and noncritically ill patients, with infection and other causes of fever (N = 5140 participants). Treating the fever did not reduce the risk of death or reduce the risk of serious adverse events. Quality-of-life scores were not different in treated patients in the single study that evaluated quality of life. The authors did not report whether study identification and abstraction were performed in duplicate (which is the standard approach). Risk of bias, which was assessed independently by 2 researchers, was high for most of the studies (in other words, the studies were not performed well). There was little heterogeneity among the trials, except for the outcome of nonserious adverse events.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Overly Generalized
While in general, avoidance of fever may not be as important clinically, this kind of study doesn’t narrow into certain subgroups well, ie patients with raised ICP/brain injury for whom normothermia is essential to lessen risk of secondary injury.
Treating fever
I still find that giving children antipyretics imprves their quality of life
Antipyretics
Degree of pyrexia should have been defined
Fever management
Don't treat a number, treat a patient
Unlikely to change my management of fever
It's odd how only 1 study out of 42 looked at quality of life. I know I always feel crummy when I have a fever, so I can't imagine NOT taking an antipyretic just because it won't change mortality risk.
RX OF FEVER IN ADULTS
NOT SURE WHETHER IT REDUCES MORTALITY