Mistry Rakesh D, Stevens Molly W, Gorelick Marc H
Department of Pediatrics, University of Pennsylvania School of Medicine, USA.
Pediatr Emerg Care. 2007 Sep;23(9):617-23. doi: 10.1097/PEC.0b013e318149f639.
To describe short-term outcomes relevant to children and their caregivers after evaluation in the emergency department (ED) for febrile illnesses.
This was a prospective cohort study of children aged 28 days to 18 years presenting with fever (> or =38 degrees C), or chief complaint of fever, who were evaluated and discharged to home from tertiary care pediatric ED. Enrollment occurred on randomly selected study days over 1 year. Caregivers were then contacted via telephone after 7 to 10 days to assess outcomes, including days of fever, child and family activity impairments, as well as return to health care.
Follow-up was complete for 322 (72%) of 451 enrolled subjects. Mean age of subjects was 31.5 months. The most common discharge diagnosis was undifferentiated febrile illness (20.5%). Mean total duration of fever was 4.41 days (95% confidence interval [CI], 4.14-4.81); 38.9% remained febrile for 5 days or longer. For children, impairments in each outcome (activity, oral intake, sleep, behavior) persisted longer than 2.5 days; over 14% of them remained impaired at follow-up in each outcome. Children missed a mean of 2.63 days of day care or school (95% CI, 2.21-3.06); 37.4% missed 3 days or longer. Primary caregivers missed 1.47 days of work or school (95% CI, 1.19-1.75); 10.5% missed 5 days or longer. After ED evaluation, 23.7% made a nonscheduled revisit to the primary medical doctor or ED.
Children, and their caregivers, experience prolonged fever and impairments in activities, and frequently relapse to health care as a result of febrile illnesses. Often considered minor in nature, febrile illnesses have considerable effects on the child, caregivers, and families after ED evaluation.
描述因发热性疾病在急诊科（ED）接受评估后儿童及其照顾者的短期结局。
这是一项前瞻性队列研究，研究对象为年龄在28天至18岁之间、出现发热（≥38摄氏度）或主诉发热的儿童，这些儿童在三级护理儿科急诊科接受评估后出院回家。在1年多的时间里，在随机选择的研究日进行入组。然后在7至10天后通过电话联系照顾者，以评估结局，包括发热天数、儿童和家庭活动受限情况以及再次就医情况。
451名入组受试者中有322名（72%）完成了随访。受试者的平均年龄为31.5个月。最常见的出院诊断是不明原因发热性疾病（20.5%）。发热的平均总持续时间为4.41天（95%置信区间[CI]，4.14 - 4.81）；38.9%的儿童发热持续5天或更长时间。对于儿童，每项结局（活动、口服摄入量、睡眠、行为）的受限持续时间超过2.5天；超过14%的儿童在随访时每项结局仍受限。儿童平均缺课或缺托2.63天（95%CI，2.21 - 3.06）；37.4%的儿童缺课或缺托3天或更长时间。主要照顾者平均误工或缺课1.47天（95%CI，1.19 - 1.75）；10.5%的照顾者误工或缺课5天或更长时间。在急诊科评估后，23.7%的儿童再次非计划地就诊于初级医生或急诊科。
儿童及其照顾者会经历长时间发热和活动受限，并且由于发热性疾病经常再次就医。发热性疾病通常被认为性质较轻，但在急诊科评估后，对儿童、照顾者和家庭有相当大的影响。
