Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study

Abstract

ObjectiveMost studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED.Design and settingThe MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12–18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection).Results37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as highly urgent (38.9% vs 34.5%) and described as ill appearing (23.1% vs 15.6%) than younger children. Increased work of breathing and a non-blanching rash were present less often in adolescents, while neurological signs were present more often (1% vs 0%). C reactive protein tests were performed more frequently in adolescents and were more often abnormal (adjusted OR (aOR) 1.7, 95% CI 1.5 to 1.9). Adolescents were more often diagnosed with SBI (OR 1.8, 95% CI 1.6 to 2.0) and sepsis/meningitis (OR 2.3, 95% CI 1.1 to 5.0) and were more frequently admitted (aOR 1.3, 95% CI 1.2 to 1.4) and treated with intravenous antibiotics (aOR 1.7, 95% CI 1.5 to 2.0).ConclusionsAlthough younger children presented to the ED more frequently, adolescents were more often diagnosed with SBI and sepsis/meningitis. Our data emphasise the importance of awareness of severe infections in adolescents.

A Novel Combination of Host Protein Biomarkers to Distinguish Bacterial From Viral Infections in Febrile Children in Emergency Care

“…This study is a sub-study of the Biomarker Validation Study (BIVA), which is embedded in the Personalised Risk assessment of Febrile Illness to Optimise Real-life Management project (PER-FORM project across the European Union). 9 This study aims to develop and validate new tools to distinguish bacterial from viral infections. In the BIVA study, febrile children were prospectively recruited if blood samples were collected on clinical indication and clinical data were extracted from electronic health records.…”

European study confirms the combination of fever and petechial rash as an important warning sign for childhood sepsis and meningitis

“…The study comprised 12 emergency departments from eight different countries: one in Austria, Germany, Greece, Latvia, Spain and Slovenia and three each in the Netherlands and the United Kingdom. All the study sites were either tertiary university hospitals or large teaching hospitals 13 . Consecutive patient recruitment was performed for at least 1 year in the study period from 1 January 2017 to 30 April 2018.…”

“…All the study sites were either tertiary university hospitals or large teaching hospitals. 13 Consecutive patient recruitment was performed for at least 1 year in the study period from 1 January 2017 to 30 April 2018. The periods of active data collection per month differed in the participating hospitals, ranging from 1 week per month to the entire month.…”

Emergency medical services utilisation among febrile children attending emergency departments across Europe: an observational multicentre study

“…Advanced diagnostics included any kind of imaging, blood culture, and lumbar puncture. ILSI consist of five categories [23] (Appendix C).…”