Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
PLoS One. 2021 Jan 7;16(1):e0244810. doi: 10.1371/journal.pone.0244810. eCollection 2021.
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.
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.
Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018).
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.
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).
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.
在观察性急诊科 (ED) 研究中，住院通常被用作疾病严重程度的标志物。ED 入院率的比较很复杂，可能受到地区、ED、医生和患者特征的影响。我们旨在研究发热儿童 ED 入院率的变化，评估其是否可由疾病严重程度解释，并确定入院率差异较大的患者群体，以便利用这些数据减少因实践差异而导致的不必要的医疗保健利用。
MOFICHE（欧洲儿童发热管理和结局研究的一部分，是 PERFORM 研究的一部分，www.perform2020.org）是一项前瞻性队列研究，使用常规收集的发热儿童数据，包括患者特征（年龄、转诊、生命体征和临床报警体征）、诊断性检查、治疗、诊断和住院。
2017-2018 年，数据收集于 12 个欧洲 ED 就诊的 0-18 岁发热儿童。
我们通过调整 ED 患者特征和初始检查后，使用标准化入院率比较 ED 之间的入院率，标准化率>1 表明入院率高于预期，率<1 表示基于 ED 患者人群的入院率低于预期。
我们纳入了 38120 名儿童。其中，9.695 名（25.4%）被收治到普通病房（ED 范围为 5.1-54.5%）。调整后的标准化入院率在 0.6 到 1.5 之间。最短入院率（0.1-5.0）、PICU 入院率（0.2-2.2）、上呼吸道感染（0.4-1.7）和发热无病灶（0.5-2.7）的变化最大。败血症/脑膜炎（0.9-1.1）的变化较小。
在欧洲 ED 评估的发热儿童中，入院率存在较大差异，但在纠正患者特征后，这种差异大大减少，因此总体入院率似乎能充分反映疾病严重程度或潜在的严重疾病过程。然而，对于某些患者群体，即使在调整了患者特征后，差异仍然很大。
