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

Dorine Borensztajn*, Nienke N. Hagedoorn, Enitan Carrol, Ulrich Von Both, Juan Emmanuel Dewez, Marieke Emonts, Michiel Van Der Flier, Ronald De Groot, Jethro Herberg, Benno Kohlmaier, Michael Levin, Emma Lim, Ian Maconochie, Federico Martinon Torres, Ruud Nijman, Marko Pokorn, Irene Rivero-Calle, Maria Tsolia, Clementien Vermont, Dace ZavadskaWerner Zenz, Joany Zachariasse, Henriette A. Moll

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective Most 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 setting The 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). Results 37 420 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). Conclusions Although 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.

Original languageEnglish
Article numbere053451
JournalBMJ Open
Volume12
Issue number1
DOIs
Publication statusPublished - 19 Jan 2022

Bibliographical note

Funding Information:
Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 668303. The research was supported by the National Institute for Health Research Biomedical Research Centre based at Imperial College (JH, ML) and at Newcastle Hospitals NHS Foundation Trust and Newcastle University (EL, ME).

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

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