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SHR Neuro Cancer Cardio Lipid Metab Microb
Borensztajn, DM; Hagedoorn, NN; Carrol, ED; von, Both, U; Emonts, M; van, der, Flier, M; de, Groot, R; Herberg, J; Kohlmaier, B; Levin, M; Lim, E; Maconochie, IK; Martinon-Torres, F; Nijman, RG; Pokorn, M; Rivero-Calle, I; Tsolia, M; van, der, Velden, FJS; Vermont, C; Zavadska, D; Zenz, W; Zachariasse, JM; Moll, HA.
Febrile children with comorbidities at the emergency department - a multicentre observational study.
Eur J Pediatr. 2022; 181(9):3491-3500
Doi: 10.1007/s00431-022-04552-2
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- Co-authors Med Uni Graz
- Kohlmaier Benno
- Zenz Werner
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- Abstract:
- 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). CONCLUSIONS: 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. WHAT IS KNOWN: • While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies. WHAT IS NEW: • 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Bacterial Infections - diagnosis
- Child - administration & dosage
- Comorbidity - administration & dosage
- Emergency Service, Hospital - administration & dosage
- Fever - epidemiology, microbiology
- Humans - administration & dosage
- Prospective Studies - administration & dosage
- Sepsis - administration & dosage
- Find related publications in this database (Keywords)
- Chronic disease
- Comorbidity
- Fever
- Infectious diseases
- Emergency care