Febrile children in the Emergency Department: Frequency and predictors of poor outcome

Abstract

Aim To evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department. Methods Retrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6‐month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra‐corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver‐operating characteristics curve were calculated for each predictor variable. Results Between Jan‐June 2019, 6217 children met inclusion criteria. Twenty‐seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra‐corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency. Conclusion Poor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.

Sepsis epidemiology in Australian and New Zealand children (SENTINEL): protocol for a multicountry prospective observational study

“…We conducted a precision-based sample size calculation for derivation of Sepsis-3 diagnostic criteria using death and long-term disability as outcomes. Based on pilot data and a retrospective study of 6500 children presenting to the ED with febrile illnesses at the central study site, 49 death in the proposed paediatric study population is ~2.1% and long-term disability ~14%. A sample size of 2500 eligible children with sepsis or being treated for suspected sepsis will yield approximately 52 patient deaths and 350 patients with long-term disabilities.…”

Febrile children in the emergency department: Frequency and predictors of poor outcome

“…We read with curiosity the study by Long et al regarding the outcome of febrile children in the emergency department. 1 Whilst an interesting and engaging paper, there were a few points for improvement.…”

Sepsis awareness and understanding in Australian parents: A National Child Health Poll survey

“…4,5 Fever is a main symptom of sepsis, which means that children with sepsis are hidden among the 200 000 febrile children presenting to EDs in Australia every year. 6,7 Early recognition and treatment are the biggest predictors of survival. 8 Parents have a pivotal role in improving sepsis outcomes by seeking medical attention early when they suspect a febrile illness may be due to sepsis in their child.…”

“…Sepsis causes greater than 60 paediatric deaths per year in Australia alone, the majority within 24 h of hospitalisation 4,5 . Fever is a main symptom of sepsis, which means that children with sepsis are hidden among the 200 000 febrile children presenting to EDs in Australia every year 6,7 . Early recognition and treatment are the biggest predictors of survival 8 .…”