Emergency department presentations of febrile children to an Australian public hospital

Bereznicki, Bonnie; Tucker, Madeline Ga; Beggs, Sean; Zosky, Graeme R.; Bereznicki, Lre

doi:10.1111/jpc.14071

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…Similar results were seen in various studies done in the Western world on febrile children presenting to the ED which showed pneumonia (43.7%) as most common cause of fever in <13 years old febrile children, and others being diarrhoea (17.3%) and cellulitis/adenitis (13%). [30][31][32] Finkelstein, et al reported similar findings in 3-36 months old infants in the US. 5 Studies done in Indian children also showed respiratory and the gastrointestinal illnesses as the most common diagnosis in febrile children.…”

Section: Discussionmentioning

confidence: 62%

Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Pradhan

Mishra

Juneja

et al. 2021

Int J Contemp Pediatr

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Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted children was 2 (0, 3) days. Mortality was observed in 12 (8%) children. Mortality was 4 times higher in children with CNS infections as compared to other conditions [RR=4.14 (1.4 to 12.4); P=0.01].Conclusions: Fever in the ED among Indian infants at a public hospital was mainly due to respiratory infection, which could be managed on outpatient-basis in the majority using the ACEE-INDIA (Academic College of Emergency Experts in India) guidelines. However, among those admitted, neurological conditions were the most common cause of death.

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Section: Discussionmentioning

confidence: 62%

Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Pradhan

Mishra

Juneja

et al. 2021

Int J Contemp Pediatr

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“…Also, parents who usually sought help within the first 24 hours of the onset of febrile illness were used to giving antipyretics at a lower body temperature than those who believed that a consultation by a healthcare specialist could be delayed until later. Fever is one of the main reasons for seeking healthcare specialists after hours [19,21], despite the fact that many of these consultations are nonurgent and should be managed in primary care.…”

Section: Discussionmentioning

confidence: 99%

“…As most febrile episodes in children are benign, assessment in primary care and recommendations given by a family doctor or general practitioner should largely be sufficient for management. However, fever remains one of the main reasons for nonurgent visits to out-of-hours healthcare and pediatric emergency departments [5,16,17,18,19,20]. It is also the most common reason for use of medication in children [15,21,22,23].…”

Section: Introductionmentioning

confidence: 99%

“…In their opinion, clinicians often give incomplete explanation on the nature of the disease (“it’s just a virus”) without providing explanation on what it means, on how to evaluate the severity of the child’s condition, and when to seek help [30]. Parental misconceptions on hazards of fever are not sufficiently addressed in primary care, thus leading to visits to ED that could potentially be avoided [19,31].…”

Section: Introductionmentioning

confidence: 99%

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Beliefs, Practices and Health Care Seeking Behavior of Parents Regarding Fever in Children

et al. 2019

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Background and objectives: Fever in children is one of the most common reasons for seeking medical attention. Parents often have misconceptions about the effects to fever, which leads to inappropriate use of medication and nonurgent visits to emergency departments (ED). The aim of this study was to clarify the beliefs on the effects and management of fever and to identify healthcare seeking patterns among parents of febrile children in Latvia. Materials and Methods: Parents and legal guardians of children attending ED with febrile illness were included in the study. Participants were recruited in Children’s Clinical University Hospital (CCUH) in Riga, and in six regional hospitals in Latvia. Data on beliefs about fever, administration of antipyretics, healthcare-seeking behavior, and experience in communication with health care workers were collected via questionnaire. Results: In total, 355 participants were enrolled: 199 in CCUH and 156 in regional hospitals; 59.2% of participants considered fever itself as indicative of serious illness and 92.8% believed it could raise the child’s body temperature up to a dangerous level. Antipyretics were usually administered at median temperature of 38.0 °C, and the median temperature believed to be dangerous was 39.7 °C; 56.7% of parents usually contacted a doctor within the first 24 h of the illness. Parents who believed that lower temperatures are dangerous to a child were more likely to contact a doctor earlier and out-of-hours; 60.1% of participants had contacted their family doctor prior their visit to ED. Parental evaluation of satisfaction with the information and reassurance provided by the doctors at the hospital was higher than of that provided by their family doctor; 68.2% of participants felt safer when their febrile children were treated at the hospital. Conclusions: Fever itself was regarded as indicative of serious illness and potentially dangerous to the child’s life. These misconceptions lead to inappropriate administration of antipyretics and early-seeking of medical attention, even out-of-hours. Hospital environment was viewed as safer and more reassuring when dealing with febrile illness in children. More emphasis must be placed on parental education on proper management of fever, especially in primary care

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“…A logistic regression model was used to explore the relationship between the different clinical and biochemical variables and the decision to admit or discharge a febrile child. Demographic and clinical variables were included in the model based on data from previous studies 16,17 or if they reached a level of significance of p = 0.1 in the univariate analysis. The level of significance for all tests was set at p = 0.05.…”

Section: Methodsmentioning

confidence: 99%

Children discharged from an emergency department with bacteraemia had lower C‐reactive protein and better outcomes than admissions

Gelernter

Lazarovitch²,

Kozer

et al. 2020

Acta Paediatrica

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Aim To investigate whether there are common clinical findings in bacteraemic children that were discharged from the emergency department (ED) and to follow their clinical outcome. Methods A retrospective chart review of children above one‐month‐old with positive blood cultures obtained in Shamir Medical Center's ED between January 2011 and December 2019 was conducted. Results A total of 250 cases were analysed, of which 68 discharged after first evaluation. Streptococcus pneumonia was the most commonly isolated pathogen. Compared to children that were admitted when first evaluated in the ED, discharged children had lower C‐reactive protein (mean 50.5 ± 62.8 vs 121.7 ± 113.2 mg/L, p < 0.001). Dyspnoea and being ill‐looking were less prevalent among the latter (6.7% versus 35.1%, p = <0.001, 3.0% versus 22.2% p < 0.001, respectively), as were presence of Kingella kingae and other Gram‐negative bacteria. Of the children hospitalised in our institution, the duration of hospitalisation was significantly lower than in those admitted during the first visit (6.3 ± 4.3 vs 9.0 ± 7.4 days, p = .002). None of the discharged children were admitted to paediatric intensive care unit. Conclusion Children with bacteraemia who were discharged home before knowing their positive blood cultures results had lower C‐reactive protein and better outcome compared to those admitted on first evaluation in emergency department.

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Emergency department presentations of febrile children to an Australian public hospital

Cited by 10 publications

References 18 publications

Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Beliefs, Practices and Health Care Seeking Behavior of Parents Regarding Fever in Children

Children discharged from an emergency department with bacteraemia had lower C‐reactive protein and better outcomes than admissions

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