Robert Cohen1,2,3,4, Stéphane Béchet2, Nathalie Gelbert1, Bruno Frandji5, François Vie Le Sage1, Georges Thiebault1, Fabienne Kochert1, Fabienne Cahn-Sellem1, Andreas Werner1, Naim Ouldali2,6, Corinne Levy1,2,3,4. 1. From the AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France. 2. ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne. 3. Université Paris Est, IMRB-GRC GEMINI, Créteil, France. 4. Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France. 5. CompuGroup Medical France, Nanterre, France. 6. Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France.
Abstract
BACKGROUND: Many ambulatory networks in several countries have established syndromic surveillance systems to detect outbreaks of different illnesses. Here, we describe a new Pediatric and Ambulatory Research in Infectious diseases network that combined automated data extraction from the computers of primary care pediatricians. METHODS: Pediatricians who used the same software, AxiSanté 5-Infansoft for electronic medical records were specially trained in infectious diseases, encouraged to comply with French treatments' recommendations, use of point-of-care tests and vaccination guidelines. Infectious disease diagnoses in children <16 years old in the records triggered automatic data extraction of complete records. A quality control process and external validation were developed. RESULTS: From September 2017 to February 2020, 107 pediatricians enrolled 57,806 children (mean age 2.9 ± 2.6 years at diagnosis) with at least one infectious disease diagnosis among those followed by the network. Among the 118,193 diagnoses, the most frequent were acute otitis media (n = 44,924, 38.0%), tonsillopharyngitis (n = 13,334, 11.3%), gastroenteritis (n = 12,367, 10.5%), influenza (n = 11,062, 9.4%), bronchiolitis (n = 10,531, 8.9%), enteroviral infections (n = 8474, 7.2%) and chickenpox (n = 6857, 5.8%). A rapid diagnostic test was performed in 84.7% of cases of tonsillopharyngitis and was positive in 44%. The antibiotic recommendations from French guidelines were strictly followed: amoxicillin was the most prescribed antibiotic and less than 10% of presumed viral infections were treated. CONCLUSIONS: This "tailor-made" network set up with quality controls and external validation represents a new approach to the surveillance of pediatric infectious diseases in the digital era and could highly optimize pediatric practices.
BACKGROUND: Many ambulatory networks in several countries have established syndromic surveillance systems to detect outbreaks of different illnesses. Here, we describe a new Pediatric and Ambulatory Research in Infectious diseases network that combined automated data extraction from the computers of primary care pediatricians. METHODS: Pediatricians who used the same software, AxiSanté 5-Infansoft for electronic medical records were specially trained in infectious diseases, encouraged to comply with French treatments' recommendations, use of point-of-care tests and vaccination guidelines. Infectious disease diagnoses in children <16 years old in the records triggered automatic data extraction of complete records. A quality control process and external validation were developed. RESULTS: From September 2017 to February 2020, 107 pediatricians enrolled 57,806 children (mean age 2.9 ± 2.6 years at diagnosis) with at least one infectious disease diagnosis among those followed by the network. Among the 118,193 diagnoses, the most frequent were acute otitis media (n = 44,924, 38.0%), tonsillopharyngitis (n = 13,334, 11.3%), gastroenteritis (n = 12,367, 10.5%), influenza (n = 11,062, 9.4%), bronchiolitis (n = 10,531, 8.9%), enteroviral infections (n = 8474, 7.2%) and chickenpox (n = 6857, 5.8%). A rapid diagnostic test was performed in 84.7% of cases of tonsillopharyngitis and was positive in 44%. The antibiotic recommendations from French guidelines were strictly followed: amoxicillin was the most prescribed antibiotic and less than 10% of presumed viral infections were treated. CONCLUSIONS: This "tailor-made" network set up with quality controls and external validation represents a new approach to the surveillance of pediatric infectious diseases in the digital era and could highly optimize pediatric practices.
Authors: Pr Robert Cohen; Alexis Rybak; Andreas Werner; Stéphane Béchet; Roxane Desandes; Fréderic Hassid; Jean-Marie André; Nathalie Gelbert; Georges Thiebault; Fabienne Kochert; Fabienne Cahn-Sellem; François Vié Le Sage; Pr François Angoulvant; Naïm Ouldali; Bruno Frandji; Corinne Levy Journal: Lancet Reg Health Eur Date: 2022-08-23