In the Netherlands approximately 500.000 children attend hospital emergency departments each year. Children with fever are responsible for about 50% of the paediatric emergency admissions (1). These children pose a diagnostic challenge at the paediatric emergency department (ED), since fever may have various causes, ranging from serious bacterial infections (e.g. meningitis, septicaemia, pneumonia, urinary tract infection) to self-limiting viral infections (2). Currently, these patients are ob
Conditions
Interventions
At the moment of triage, variables included in the decision rule for children with fever are documented in the electronic patient record by the nurse. Based on these data, the decision rule will class
2. Risk of Pneumonia high: Nursing staff arranges a X-ray
3. Risk of ‘SBI other’ low: Nursing staff arranges a urine dipstick
4. Risk of ‘SBI other’ high: Urine culture through catherization/ midstream urine.
Arm 2: Usual care (controls).
Sponsors
Erasmus Medical Center, Sophia Children's hospital
Eligibility
Inclusion criteria
Inclusion criteria: Children aged 1 month - 16 years, visiting the paediatric emergency department of the ErasmusMC-Sophia with fever.
Exclusion criteria
Exclusion criteria: 1. Fever with a clear focus of only rhinitis or otitis; 2. Children with chronic morbidity, like: cystic fibrosis; broncho-pulmonary dysplasia; nephrotic syndrome and renal insufficiency; psychomotor retardation (Gross Motor Function Classification Scale IV and V); short bowel syndrome; malignancy currently in treatment regimen; immune deficiency, neutropenia; using immunosuppression medication; haemodynamic unstable heart disease.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Patient outcome: 1. Correct diagnosis (feverish children with serious bacterial infections); 2. False positive errors (children without the target diagnosis incorrectly exposed to diagnostic tests); 3. False negative errors (children with the target diagnosis incorrectly refrained from diagnostic tests). | — |
Secondary
| Measure | Time frame |
|---|---|
| Process outcome: 1. Patient's consultation time spent at the emergency department; 2. The number of diagnostic procedures (chest radiography, blood, urine and liquor tests and cultures); 3. Treatment procedures (antibiotic prescriptions), number of hospitalizations; 4. Follow up consultations within 1 week. Costs: Costs of diagnostic tests at the emergency department visit, initiated treatment, hospitalization, costs of missed diagnosis and their adverse events, costs of emergency care nurses and physicians. | — |
Contacts
Public ContactR. Oostenbrink
P.O.box 2060
Outcome results
None listed