Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands.
Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Eur J Pediatr. 2022 Dec;181(12):4199-4209. doi: 10.1007/s00431-022-04606-5. Epub 2022 Sep 30.
Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0-18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0-2.3). Management per ED varied as follows: use of diagnostic tests 14-83%, antibiotic treatment 23-54%, admission 34-86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0-38%), partial adherence occurred in 56% (484/868, range 35-77%).
There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.
• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. • There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence.
• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe. • Guideline revision including new biomarkers is needed to improve management in young febrile children.
评估欧洲急诊部门（ED）中 3 月龄以下发热儿童的管理是否符合发热指南。本研究为 MOFICHE 研究的一部分，该研究是一项观察性多中心研究，包括来自 8 个欧洲国家的 12 个 ED 中 0-18 岁发热儿童的常规数据。在 3 月龄以下（不包括细支气管炎）发热儿童中，我们分析了实际管理与发热指南的比较。10 个 ED 应用了（改编的）NICE 指南，2 个 ED 应用了当地指南。管理包括诊断性检查、抗生素治疗和住院。共纳入 913 名年龄中位数为 1.7 个月（IQR 1.0-2.3）的儿童。各 ED 的管理情况如下：使用诊断性检查的比例为 14-83%，抗生素治疗的比例为 23-54%，住院的比例为 34-86%。血培养的指南符合率为 43%（374/868），腰椎穿刺的指南符合率为 29%（144/491），抗生素处方的指南符合率为 55%（270/492），住院的指南符合率为 67%（573/859）。四项管理措施完全符合的比例为 15%（132/868，范围 0-38%），部分符合的比例为 56%（484/868，范围 35-77%）。
管理上存在较大的实践差异。指南的符合率有限，但住院治疗的符合率最高，这表明采用了谨慎的方法。未来的研究应侧重于指南修订，包括新的生物标志物，以优化对年轻发热儿童的管理。
• 3 月龄以下发热儿童有发生严重细菌感染的更高风险，这通常导致广泛的诊断和治疗。• 由于指南及其使用和遵循的差异，年轻发热儿童的管理存在实践差异。
• 在欧洲，3 月龄以下发热儿童的完全符合指南的比例有限，而部分符合指南的比例适中。• 需要修订指南，包括新的生物标志物，以改善对年轻发热儿童的管理。
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