Diagnostic variation for febrile children in European emergency departments

Lorenzo Zanetto, Josephine van de Maat, Daan Nieboer, Henriette Moll, Alain Gervaix, Liviana Da Dalt, Santiago Mintegi, Silvia Bressan*, Rianne Oostenbrink

*Corresponding author for this work

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The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23–14.53), 19.46 (3.66–103.60), 3.13 (2.29–4.26), 10.84 (6.35–18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98–3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00–20.61).

Conclusion: the use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation.

What is Known:

• Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs.

• A deeper knowledge of variability and its determinants can steer optimization of care.

What is New:

• The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability.

• Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.

Original languageEnglish
Pages (from-to)2481-2490
Number of pages10
JournalEuropean Journal of Pediatrics
Issue number6
Early online date21 Mar 2022
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
We would like to thank Elles van de Voort, M.D., for her contribution to the primary data collection. The REPEM group was responsible for local data collection. This study is performed by SHIVER, a focus group on Studies in cHIldren with feVER, within the REPEM network (Research in European Paediatric Emergency Medicine), with the following members: Denmark: H Olesen, C Lybæch Bønnelykke (Aarhus Universitetshospital, Skejby); France: F Angoulvant (Necker-Enfants Malades, Paris), F Dubos (Roger Salengro Hospital, Lille), C Gras-Leguen (Hopital Mère-Enfant, Lille), M Desmarest, M Aurel (Robert Debre Hospital, Paris), V Gajdos, C Joffre (Antoine Beclère’s Hospital, Paris); Hungary: Z Bognar (Heim Pal Children’s Hospital, Budapest); Italy: N Parri, V Fichera (Meyer Children’s University Hospital, Florence), A Arrhigini (Ospedale dei Bambini, Brescia), S Bressan, L Da Dalt, L Zanetto (University Hospital Padova, Padua); Netherlands: H A Moll, R Oostenbrink (Erasmus Medical Center Sophia Children’s Hospital, Rotterdam), M van Veen (Franciscus Gasthuis and Vlietland, Rotterdam, currently working in Groene Hart Ziekenhuis, Gouda), J Noordzij (Reinier de Graaf Gasthuis, Delft), F Smit (Maasstad Ziekenhuis, Rotterdam), A-M van Wermeskerken (Flevoziekenhuis, Almere); Portugal: S Pinto, G Sá (Hospital de Santa Maria, Lisbon), P Mação (Pediatric Hospital and Coimbra Hospital and University Centre, Coimbra), D Silva, M Zarcos (Centro Hospitalar de Leiria, Leiria); Romania: D Moldovan (Tirgu Mures Emergency Clinical County Hospital, Tirgu Mures), D-M N Dreghiciu (Clinical Emergency Hospital for Children, Cluj-Napoca); Spain: S Mintegi, Y Acedo (Cruces University Hospital, Bilbao), L Herrero Garcia (Hospital Mendaro, Mendaro), I Medina, J A Cózar (San Agustin University Hospital, Linares), J L Fernandes Arribas (Hospital Universitario Rio Hortega, Valladolid); Switzerland: M Seiler (Children’s Hospital of Zurich, Zurich), A Gervaix (University Hospital of Geneva, Geneva); UK: I Maconochie (St Mary’s Hospital, London); Turkey: H L Yilmaz, S Sari Gokay (Cukurova University Medical Faculty, Adana).

Publisher Copyright:
© 2022, The Author(s).


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