TY - JOUR
T1 - Guideline adherence in febrile children below 3 months visiting European Emergency Departments
T2 - an observational multicenter study
AU - Tan, Chantal D.
AU - van der Walle, Eline E.P.L.
AU - Vermont, Clementien L.
AU - von Both, Ulrich
AU - Carrol, Enitan D.
AU - Eleftheriou, Irini
AU - Emonts, Marieke
AU - van der Flier, Michiel
AU - de Groot, Ronald
AU - Herberg, Jethro
AU - Kohlmaier, Benno
AU - Levin, Michael
AU - Lim, Emma
AU - Maconochie, Ian
AU - Martinon-Torres, Federico
AU - Nijman, Ruud G.
AU - Pokorn, Marko
AU - Rivero-Calle, Irene
AU - Tsolia, Maria
AU - Yeung, Shunmay
AU - Zenz, Werner
AU - Zavadska, Dace
AU - Moll, Henriëtte A.
AU - Levin, Michael
AU - Cunnington, Aubrey
AU - De, Tisham
AU - Herberg, Jethro
AU - Kaforou, Myrsini
AU - Wright, Victoria
AU - Baumard, Lucas
AU - Bellos, Evangelos
AU - D’Souza, Giselle
AU - Galassini, Rachel
AU - Habgood-Coote, Dominic
AU - Hamilton, Shea
AU - Hoggart, Clive
AU - Hourmat, Sara
AU - Jackson, Heather
AU - Maconochie, Ian
AU - Menikou, Stephanie
AU - Lin, Naomi
AU - de Groot, Ronald
AU - van der Flier, Michiel
AU - van Aerde, Koen
AU - Heidema, J.
AU - Miedema, C. J.
AU - Jongerius, Ilse
AU - van den Berg, J. M.
AU - Schonenberg, D.
AU - Zandstra, Judith
N1 - Funding Information:
This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No. 848196. The Research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. For the remaining authors, no sources of funding were declared. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0–18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0–2.3). Management per ED varied as follows: use of diagnostic tests 14–83%, antibiotic treatment 23–54%, admission 34–86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0–38%), partial adherence occurred in 56% (484/868, range 35–77%). Conclusion: There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.What is Known:• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment.• There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence.What is New:• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe.• Guideline revision including new biomarkers is needed to improve management in young febrile children.
AB - Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0–18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0–2.3). Management per ED varied as follows: use of diagnostic tests 14–83%, antibiotic treatment 23–54%, admission 34–86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0–38%), partial adherence occurred in 56% (484/868, range 35–77%). Conclusion: There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.What is Known:• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment.• There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence.What is New:• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe.• Guideline revision including new biomarkers is needed to improve management in young febrile children.
KW - Children
KW - Emergency care
KW - Fever
KW - Guideline
KW - Pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85139213681&partnerID=8YFLogxK
U2 - 10.1007/s00431-022-04606-5
DO - 10.1007/s00431-022-04606-5
M3 - Article
C2 - 36178539
AN - SCOPUS:85139213681
SN - 0340-6199
VL - 181
SP - 4199
EP - 4209
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 12
ER -