Department of Women's and Children's Health, University of Padova, Padua, 35128, Italy.
Department of General Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, 3015 CN, Netherlands.
Eur J Pediatr. 2022 Jun;181(6):2481-2490. doi: 10.1007/s00431-022-04417-8. Epub 2022 Mar 21.
The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23-14.53), 19.46 (3.66-103.60), 3.13 (2.29-4.26), 10.84 (6.35-18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98-3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00-20.61).
the use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation.
• Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs. • A deeper knowledge of variability and its determinants can steer optimization of care.
• The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. • Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.
探索欧洲急诊科接诊发热儿童时使用诊断检测的情况，确定医院间差异的决定因素，以及检测使用与住院之间的关联。我们对涉及 11 个国家 28 家儿科急诊科的横断面观察性研究进行了二次分析。共纳入 4560 名＜16 岁的发热就诊患儿，排除了新生儿和伴有相关合并症的患儿。我们的主要结局指标是根据国家和感染部位，评估后接受检测的患儿比例。通过多水平回归分析，针对医院间差异和血液检测对患者处置的影响进行了探索，调整了患者特征（年龄组、分诊级别、表现、发热持续时间、感染部位）和医院类型（学术型、教学型、其他型）。常规诊断检测的使用差异很大，主要是血液检测的使用，各医院的总体使用率为 3%至 75%。＜3 个月龄、高紧急程度分诊级别、表现不佳、疑似尿路感染与血液检测的相关性最强（比值比（OR）分别为 8.71（95%置信区间 5.23-14.53）、19.46（3.66-103.60）、3.13（2.29-4.26）、10.84（6.35-18.50））。医院间血液检测的差异仍然很大（最终模型中位数 OR 2.36，1.98-3.54）。血液检测与住院之间存在正相关（OR 13.62，9.00-20.61）。
欧洲急诊科接诊发热儿童时，诊断检测的使用存在很大差异，但患者和医院特征只能部分解释医院间的差异。参与现场的重点小组应有助于确定意外差异的原因。
• 尽管先前的研究表明，在发热儿童的急诊科管理方面存在差异，但有关欧洲急诊科使用诊断检测的信息有限。• 更深入地了解变异性及其决定因素可以指导优化护理。
• 欧洲急诊科接诊发热儿童时，诊断检测的使用存在很大差异，但患者和医院特征只能部分解释医院间的差异。• 有关中心间比较的数据为进一步探索影响不合理差异的因素提供了机会。
