Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational multicenter study

Chantal D. Tan, Eline E. P. L. van der Walle, PERFORM Consortium Personalised Ri, Clementien L. Vermont, Ulrich von Both, Enitan D. Carrol, Irini Eleftheriou, Marieke Emonts, Michiel van der Flier, Ronald de Groot, Jethro Herberg, Benno Kohlmaier, Michael Levin, Emma Lim, Ian K. Maconochie, Federico Martinon-Torres, Ruud G. Nijman, Marko Pokorn, Irene Rivero-Calle, Maria TsoliaShunmay Yeung, Werner Zenz, Dace Zavadska, Henriette A. Moll*

*Corresponding author for this work

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Abstract

Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0-18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0-2.3). Management per ED varied as follows: use of diagnostic tests 14-83%, antibiotic treatment 23-54%, admission 34-86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0-38%), partial adherence occurred in 56% (484/868, range 35-77%).

Conclusion: There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.

Original languageEnglish
Pages (from-to)4199-4209
Number of pages11
JournalEuropean Journal of Pediatrics
Volume181
Issue number12
DOIs
Publication statusE-pub ahead of print - 30 Sep 2022

Bibliographical note

Funding: This project has received funding from the European Union’s
Horizon 2020 research and innovation program under grant agreement
No. 848196. 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.

© The Author(s) 2022, corrected publication 2022

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