TY - JOUR
T1 - Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe
T2 - PERFORM, a multicentre prospective observational study
AU - Borensztajn, Dorine M.
AU - Hagedoorn, Nienke N.
AU - Calle, Irene Rivero
AU - Maconochie, Ian K.
AU - von Both, Ulrich
AU - Carrol, Enitan D.
AU - Dewez, Juan Emmanuel
AU - Emonts, Marieke
AU - van der Flier, Michiel
AU - de Groot, Ronald
AU - Herberg, Jethro
AU - Kohlmaier, Benno
AU - Lim, Emma
AU - Martinon-Torres, Federico
AU - Nieboer, Daan
AU - Nijman, Ruud G.
AU - Pokorn, Marko
AU - Strle, Franc
AU - Tsolia, Maria
AU - Vermont, Clementien
AU - Yeung, Shunmay
AU - Zavadska, Dace
AU - Zenz, Werner
AU - Levin, Michael
AU - Moll, Henriette A.
N1 - Funding Information:
This project was funded by the European Union?s Horizon 2020 research and innovation programme to ML (Grant No. 668303), the NIHR Newcastle Biomedical Research Centre at Newcastle Hospitals NHS foundation trust to ME, and the National Institute for Health Research to RGN (CL-2018-21-007). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 Borensztajn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/1/7
Y1 - 2021/1/7
N2 - OBJECTIVES: Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation.DESIGN: MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission.SETTING AND PARTICIPANTS: Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018).MAIN OUTCOME MEASURES: We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population.RESULTS: We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1-54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1-5.0), PICU admission rates (0.2-2.2), upper respiratory tract infections (0.4-1.7) and fever without focus (0.5-2.7). Variation was small in sepsis/meningitis (0.9-1.1).CONCLUSIONS: Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.
AB - OBJECTIVES: Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation.DESIGN: MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission.SETTING AND PARTICIPANTS: Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018).MAIN OUTCOME MEASURES: We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population.RESULTS: We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1-54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1-5.0), PICU admission rates (0.2-2.2), upper respiratory tract infections (0.4-1.7) and fever without focus (0.5-2.7). Variation was small in sepsis/meningitis (0.9-1.1).CONCLUSIONS: Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.
UR - http://www.scopus.com/inward/record.url?scp=85099467098&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0244810
DO - 10.1371/journal.pone.0244810
M3 - Article
C2 - 33411810
AN - SCOPUS:85099467098
SN - 1932-6203
VL - 16
SP - e0244810
JO - PloS one
JF - PloS one
IS - 1
M1 - e0244810
ER -