Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
Eur J Pediatr. 2022 Sep;181(9):3491-3500. doi: 10.1007/s00431-022-04552-2. Epub 2022 Jul 7.
We aimed to describe characteristics and management of children with comorbidities attending European emergency departments (EDs) with fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last > 1 year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, p < 0.001), had an ED-Paediatric Early Warning Score of > 15 (22 versus 12%, p < 0.001), or a C-reactive protein > 60 mg/l (aOR 1.4 (95%CI 1.3-1.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2-3.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1-2.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1-2.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8-7.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7-2.0), including sepsis/meningitis (aOR 4.6, 95%CI 3.2-6.7). Children most at risk for sepsis/meningitis were children with malignancy/immunodeficiency (aOR 14.5, 8.5-24.8), while children with psychomotor delay/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1-6.9) or PICU admission (aOR 9.7, 6.1-15.5).
Our data show how children with comorbidities are a population at risk, as they more often are diagnosed with bacterial infections and more often require PICU admission and life-saving interventions.
• While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies.
• Children with comorbidities in general are more ill upon presentation than children without comorbidities. • Children with comorbidities form a heterogeneous group; specific subgroups have an increased risk for invasive bacterial infections, while others have an increased risk of invasive interventions such as PICU admission, regardless of the cause of the fever.
描述在欧洲急诊部（ED）就诊的合并症儿童的特征和管理情况。MOFICHE（欧洲儿童发热的管理和结局）是一项前瞻性多中心研究（12 个欧洲 ED，8 个国家）。比较了有合并症的发热儿童与无合并症的儿童在患者特征、疾病严重程度标志物、管理和诊断方面的差异。合并症的定义是预计持续时间超过 1 年的慢性基础疾病。我们进行了多变量逻辑回归分析，显示了调整后的优势比（aOR），并根据患者特征进行了调整。我们纳入了 38110 名患者，其中 5906 名（16%）有合并症。最常见的合并症是肺部、神经或早产。有合并症的患者往往表现得更差（20%比 16%，p<0.001），急诊儿科预警评分（ED-Paediatric Early Warning Score）>15 分的患者（22%比 12%，p<0.001）或 C 反应蛋白（CRP）>60mg/L 的患者（aOR 1.4[95%CI 1.3-1.6]）。他们更经常需要救生干预（aOR 2.7，95%CI 2.2-3.3），接受静脉内抗生素治疗（aOR 2.3，95%CI 2.1-2.5），并被收治到病房（aOR 2.2，95%CI 2.1-2.4）或儿科重症监护病房（PICU）（aOR 5.5，95%CI 3.8-7.9）。他们更经常被诊断为严重细菌感染（aOR 1.8，95%CI 1.7-2.0），包括败血症/脑膜炎（aOR 4.6，95%CI 3.2-6.7）。最有可能发生败血症/脑膜炎的儿童是患有恶性肿瘤/免疫缺陷的儿童（aOR 14.5，8.5-24.8），而患有精神运动发育迟缓/神经系统疾病的儿童最有可能需要救生干预（aOR 5.3，4.1-6.9）或 PICU 入院（aOR 9.7，6.1-15.5）。
我们的数据表明，合并症儿童是一个处于危险中的人群，因为他们更经常被诊断为细菌感染，更经常需要 PICU 入院和救生干预。
• 虽然合并症儿童构成了 ED 常客的大部分，但他们经常被排除在研究之外。
• 一般来说，有合并症的儿童在就诊时比没有合并症的儿童病情更严重。• 有合并症的儿童是一个异质群体；特定亚组发生侵袭性细菌感染的风险增加，而其他亚组发生侵袭性干预（如 PICU 入院）的风险增加，无论发热的原因是什么。
