Dorine M Borensztajn1, Nienke N Hagedoorn1, Irene Rivero Calle2, Ian K Maconochie3, Ulrich von Both4, Enitan D Carrol5,6, Juan Emmanuel Dewez7, Marieke Emonts8,9,10, Michiel van der Flier11,12,13, Ronald de Groot14, Jethro Herberg3, Benno Kohlmaier15, Emma Lim8, Federico Martinon-Torres2, Daan Nieboer16, Ruud G Nijman3, Marko Pokorn17, Franc Strle17, Maria Tsolia18, Clementien Vermont19, Shunmay Yeung7, Dace Zavadska20, Werner Zenz15, Michael Levin3, Henriette A Moll1. 1. Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2. Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. 3. Section of Paediatric Infectious Diseases, Imperial College of Science, Technology and Medicine, London, United Kingdom. 4. Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig, Ludwig-Maximilians-Universität (LMU), München, Germany. 5. Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom. 6. Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. 7. Faculty of Tropical and Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom. 8. Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom. 9. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. 10. NIHR Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom. 11. Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. 12. Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands. 13. Department of Laboratory Medicine, Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. 14. Stichting Katholieke Universiteit, Radboudumc Nijmegen, Nijmegen, The Netherlands. 15. Department of General Paediatrics, Medical University of Graz, Graz, Austria. 16. Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 17. Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni Klinični Center, Ljubljana, Slovenia. 18. Second Department of Paediatrics, National and Kapodistrian University of Athens, P. and A. Kyriakou Children's Hospital, Athens, Greece. 19. Department Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 20. Department of Pediatrics, Rīgas Stradiņa Universitāte, Children Clinical University Hospital, Riga, Latvia.
Abstract
OBJECTIVES: 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. DESIGN: 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. SETTING AND PARTICIPANTS: Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018). MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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. DESIGN: 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. SETTING AND PARTICIPANTS: Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018). MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Jocelyn Gravel; Eleanor Fitzpatrick; Serge Gouin; Kelly Millar; Sarah Curtis; Gary Joubert; Kathy Boutis; Chantal Guimont; Ran D Goldman; Alexander S Dubrovsky; Robert Porter; Darcy Beer; Quynh Doan; Martin H Osmond Journal: Ann Emerg Med Date: 2012-07-27 Impact factor: 5.721
Authors: Joany M Zachariasse; Nienke Seiger; Pleunie P M Rood; Claudio F Alves; Paulo Freitas; Frank J Smit; Gert R Roukema; Henriëtte A Moll Journal: PLoS One Date: 2017-02-02 Impact factor: 3.240
Authors: Jan Yvan Jos Verbakel; Tine De Burghgraeve; Ann Van den Bruel; Samuel Coenen; Sibyl Anthierens; Louise Joly; Annouschka Laenen; Jeroen Luyten; An De Sutter Journal: BMJ Open Date: 2022-01-03 Impact factor: 2.692
Authors: Dorine M Borensztajn; Nienke N Hagedoorn; Enitan D Carrol; Ulrich von Both; Juan Emmanuel Dewez; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Jethro Herberg; Benno Kohlmaier; Emma Lim; Ian K Maconochie; Federico Martinon-Torres; Daan Nieboer; Ruud G Nijman; Rianne Oostenbrink; Marko Pokorn; Irene Rivero Calle; Franc Strle; Maria Tsolia; Clementien L Vermont; Shunmay Yeung; Dace Zavadska; Werner Zenz; Michael Levin; Henriette A Moll Journal: Lancet Reg Health Eur Date: 2021-07-12