TY - JOUR
T1 - Characteristics and management of adolescents attending the ED with fever
T2 - A prospective multicentre study
AU - Borensztajn, Dorine
AU - Hagedoorn, Nienke N.
AU - Carrol, Enitan
AU - Von Both, Ulrich
AU - Dewez, Juan Emmanuel
AU - Emonts, Marieke
AU - Van Der Flier, Michiel
AU - De Groot, Ronald
AU - Herberg, Jethro
AU - Kohlmaier, Benno
AU - Levin, Michael
AU - Lim, Emma
AU - Maconochie, Ian
AU - Martinon Torres, Federico
AU - Nijman, Ruud
AU - Pokorn, Marko
AU - Rivero-Calle, Irene
AU - Tsolia, Maria
AU - Vermont, Clementien
AU - Zavadska, Dace
AU - Zenz, Werner
AU - Zachariasse, Joany
AU - Moll, Henriette A.
N1 - 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.
PY - 2022/1/19
Y1 - 2022/1/19
N2 - 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.
AB - 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.
KW - paediatric A&E and ambulatory care
KW - paediatric infectious disease & immunisation
KW - paediatrics
UR - http://www.scopus.com/inward/record.url?scp=85123661016&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-053451
DO - 10.1136/bmjopen-2021-053451
M3 - Article
C2 - 35046001
AN - SCOPUS:85123661016
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e053451
ER -
