Elshout Gijs, Kool Marijke, Bohnen Arthur M, Koes Bart W, Moll Henriëtte A, Berger Marjolein Y
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Br J Gen Pract. 2015 Sep;65(638):e578-84. doi: 10.3399/bjgp15X686485.
Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care.
To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms.
A prospective cohort study at a GPs' cooperative (GPC) out-of-hours service.
Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (>3 days) after initial contact.
Four-hundred and eighty children were analysed, and the overall risk of prolonged duration was 13% (63/480). Multivariate analysis combined model of patient history and physical examination showed that 'sore throat' (OR 2.8; 95% CI = 1.30 to 6.01) and 'lymph nodes palpable' (OR 1.87; 95% CI = 1.01 to 3.49) are predictive for prolonged duration of fever. The discriminative value of the model was low (AUC 0.64). CRP had no additive value in the prediction of prolonged duration of fever (OR 1.00; 95% CI = 0.99 to 1.01).
The derived prediction model indicates that only a few signs and symptoms are related to prolonged duration of fever. CRP has no additional value in this model. Overall, because the discriminative value of the model was low, the duration of fever cannot be accurately predicted.
基层医疗中儿童发热通常由良性感染引起，但常令家长担忧。关于发热持续时间及其预测因素的信息可能有助于安抚家长，从而减少医疗咨询。
确定基层医疗中发热儿童哪些体征和症状可预测发热持续时间延长，并评估C反应蛋白（CRP）检测对这些症状是否具有附加预测价值。
在一家全科医生合作组织（GPC）的非工作时间服务机构进行的一项前瞻性队列研究。
纳入家长称有发热症状的3个月至6岁儿童。排除标准为无法用荷兰语交流、在2周内曾参与本研究、就诊GPC后直接转诊至医院或未获得知情同意。主要结局指标为初次接触后发热持续时间延长（>3天）。
分析了480名儿童，发热持续时间延长的总体风险为13%（63/480）。多变量分析结合病史和体格检查的模型显示，“喉咙痛”（比值比2.8；95%置信区间=1.30至6.01）和“可触及淋巴结”（比值比1.87；95%置信区间=1.01至3.49）可预测发热持续时间延长。该模型的判别价值较低（曲线下面积0.64）。CRP在预测发热持续时间延长方面无附加价值（比值比1.00；95%置信区间=0.99至1.01）。
所推导的预测模型表明，仅有少数体征和症状与发热持续时间延长有关。CRP在该模型中无附加价值。总体而言，由于该模型的判别价值较低，发热持续时间无法准确预测。
