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

The PERFORM consortium (Personalized Risk assessment in febrile children to optimize Real-life Management across the European Union), Chantal D. Tan, Clementien L. Vermont, Joany Zachariasse, Ulrich von Both, Irini Eleftheriou, Marieke Emonts, Michiel van der Flier, Jethro Herberg, Benno Kohlmaier, Michael Levin, Emma Lim, Ian Maconochie, Federico Martinon-Torres, Ruud G. Nijman, Marko Pokorn, Irene Rivero-Calle, Maria Tsolia, Werner Zenz, Dace ZavadskaHenriëtte A. Moll, Enitan D. Carrol*, Michael Levin, Aubrey Cunnington, Tisham De, Jethro Herberg, Myrsini Kaforou, Ruud G. Nijman, Henriëtte A. Moll, Nienke N. Hagedoorn, Chantal D. Tan, Clementien L. Vermont, Joany Zachariasse, W. Dik, Martin Stocker, Ruud G. Nijman, Ronald de Groot, Michiel van der Flier, Esther Willems, L. de Haan, C. Neeleman, G. A. Tramper-Stranders, Marieke Emonts, Bryan Baas, Lieke Kloosterhuis, Wilma Oosthoek, Gabriella de Vries, Fabian van der Velden, N. Haas, J. M.van den Berg, A. M. Barendregt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1–42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1–59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1–0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4–1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented. What is Known: •Children constitute around 6–10% of all patients attending the emergency department by emergency medical services. •Discordant EMS use occurs in 37–61% of all children, with fever as most common presenting symptom for discordant EMS use in children. What is New: •There is large practice variation in EMS use among febrile children across Europe with discordance EMS use occurring in 29% (range 1–59%), which was associated with attendance during out of office hours and with settings with higher percentage of self-referrals to the ED. •Future research is needed focusing on non-medical factors (socioeconomic status, parental preferences and past experience, healthcare systems, referral pathways, out of hours services provision) that influence discordant EMS use in febrile children across Europe.

Original languageEnglish
Pages (from-to)3939-3947
Number of pages9
JournalEuropean Journal of Pediatrics
Volume182
Issue number9
DOIs
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 848196. CT received an additional funding from Stichting Erasmus Trustfonds. The Research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust, and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. For the remaining authors, no sources of funding were declared. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2023, The Author(s).

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