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Aldridge P, Baldock AJ, Baird J, Elson A, McGregor S. Recurrent themes from paediatric mortality and morbidity: a network perspective 2021-2023. Arch Dis Child 2024; 109:354-355. [PMID: 38233097 DOI: 10.1136/archdischild-2023-326633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Patrick Aldridge
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
| | | | - Jim Baird
- Paediatrics, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Alex Elson
- Thames Valley & Wessex Operational Delivery Network, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah McGregor
- Thames Valley & Wessex Operational Delivery Network, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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2
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Nijman RG, Cadman E, Maconochie I. Emerging art of doing less. Arch Dis Child 2023:archdischild-2023-326437. [PMID: 38041657 DOI: 10.1136/archdischild-2023-326437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Ruud Gerard Nijman
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Emily Cadman
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
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3
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Umana E, Mills C, Norman-Bruce H, Wilson K, Mitchell H, McFetridge L, Woolfall K, Lynn FA, McKeeman G, Foster S, Barrett M, Roland D, Lyttle MD, Watson C, Waterfield T. Applying clinical decision aids for the assessment and management of febrile infants presenting to emergency care in the UK and Ireland: Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study protocol. BMJ Open 2023; 13:e075823. [PMID: 37730397 PMCID: PMC10514651 DOI: 10.1136/bmjopen-2023-075823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Febrile infants 90 days and younger are at risk of invasive bacterial infections (bacteraemia and meningitis) and urinary tract infections. Together this is previously termed serious bacterial infection with an incidence of approximately 10-20%. The National Institute for Health and Care Excellence guidance advocates a cautious approach with most infants requiring septic screening, parenteral broad-spectrum antibiotics and hospital admission. Internationally, variations exist in the approach to febrile infants, with European and North American guidance advocating a tailored approach based on clinical features and biomarker testing. None of the available international clinical decision aids (CDAs) has been validated in the UK and Irish cohorts. The aim of the Febrile Infant Diagnostic Assessment and Outcome (FIDO) Study is to prospectively validate a range of CDAs in a UK and Irish population including CDAs that use procalcitonin testing. METHODS AND ANALYSIS The FIDO Study is a prospective multicentre mixed-methods cohort study conducted in UK and Irish hospitals. All infants aged 90 days and younger presenting with fever or history of fever (≥38°C) are eligible for inclusion. Infants will receive standard emergency clinical care without delay. Clinical data and blood samples will be collected, and consent will be obtained at the earliest appropriate opportunity using research without prior consent methodology. The performance and cost-effectiveness of CDAs will be assessed. An embedded qualitative study will explore clinician and caregiver views on different approaches to care and perceptions of risk. ETHICS AND DISSEMINATION This study was reviewed and approved by the Office for Research Ethics Committees Northern Ireland-Health and Social Care Research Ethics Committee B, Public Benefit and Privacy Panel for Health and Social Care Scotland, and Children's Health Ireland Research and Ethics Committee Ireland. The results of this study will be presented at academic conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05259683.
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Affiliation(s)
- Etimbuk Umana
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Clare Mills
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Hannah Norman-Bruce
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Kathryn Wilson
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, School of Mathematics & Physics, Queen's University Belfast, Belfast, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, School of Mathematics & Physics, Queen's University Belfast, Belfast, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Faculty of Health and Life Sciences, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Fiona A Lynn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gareth McKeeman
- Department of Clinical Biochemistry, HCS Belfast Health and Social Care Trust, Belfast, UK
| | - Steven Foster
- Emergency Department, Royal Hospital for Children, Glasgow, UK
| | - Michael Barrett
- Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Crumlin, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Damian Roland
- Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Chris Watson
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Thomas Waterfield
- Wellcome Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
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4
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Storch-De-Gracia P, Fernández JL, Velasco R, Saez I, Rodrigo R, Yañez S, Castellarnau E, Gil E, Del Rio P, Garrido E, Castaño A, Perez Á, Cabrerizo M, Hernández M, Pérez JJ, de la Torre MJ, Nadal G, Martínez J, Sánchez-Tatay V. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. Arch Dis Child 2023; 108:445-450. [PMID: 37019466 DOI: 10.1136/archdischild-2022-325281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae. DESIGN A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019. PATIENTS A total of 688 patients were recruited. MAIN OUTCOME MEASURES The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI. RESULTS Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3-51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%). CONCLUSIONS The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.
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Affiliation(s)
| | - Jose Luis Fernández
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Itsaso Saez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Rocío Rodrigo
- Pediatric Emergency Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sandra Yañez
- Pediatric Emergency Department, Complejo Hospitalario Universitario A Coruña, Oleiros, Spain
| | - Ester Castellarnau
- Department of Pediatrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Elena Gil
- Department of Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
| | | | - Estíbaliz Garrido
- Pediatric Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antón Castaño
- Pediatric Emergency Department, Hospital Universitario de Cabueñes, Gijon, Spain
| | - Álvaro Perez
- Department of Pediatrics, Hospital Del Tajo, Aranjuez, Spain
| | - María Cabrerizo
- Department of Pediatrics, Hospital Infanta Leonor, Madrid, Spain
| | - María Hernández
- Department of Pediatrics, Hospital Materno Infantil de Las Palmas, Las Palmas, Spain
| | | | | | - Gemma Nadal
- Department of Pediatrics, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Javier Martínez
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
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5
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Kohlmaier B, Leitner M, Hagedoorn NN, Borensztajn DM, von Both U, Carrol ED, Emonts M, van der Flier M, de Groot R, Herberg J, Levin M, Lim E, Maconochie IK, Martinon-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tan CD, Tsolia M, Vermont CL, Zachariasse JM, Zavadska D, Moll HA, Zenz W. European study confirms the combination of fever and petechial rash as an important warning sign for childhood sepsis and meningitis. Acta Paediatr 2023; 112:1058-1066. [PMID: 36866956 DOI: 10.1111/apa.16740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023]
Abstract
AIM This study investigated febrile children with petechial rashes who presented to European emergency departments (EDs) and investigated the role that mechanical causes played in diagnoses. METHODS Consecutive patients with fever presenting to EDs in 11 European emergency departments in 2017-2018 were enrolled. The cause and focus of infection were identified and a detailed analysis was performed on children with petechial rashes. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS We found that 453/34010 (1.3%) febrile children had petechial rashes. The focus of the infection included sepsis (10/453, 2.2%) and meningitis (14/453, 3.1%). Children with a petechial rash were more likely than other febrile children to have sepsis or meningitis (OR 8.5, 95% CI 5.3-13.1) and bacterial infections (OR 1.4, 95% CI 1.0-1.8) as well as need for immediate life-saving interventions (OR 6.6, 95% CI 4.4-9.5) and intensive care unit admissions (OR 6.5, 95% CI 3.0-12.5). CONCLUSION The combination of fever and petechial rash is still an important warning sign for childhood sepsis and meningitis. Ruling out coughing and/or vomiting was insufficient to safely identify low-risk patients.
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Affiliation(s)
- Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Manuel Leitner
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Nienke N Hagedoorn
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dorine M Borensztajn
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- German Centre for Infection Research, DZIF, Munich, Germany
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences Liverpool, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Marieke Emonts
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Michiel van der Flier
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, The Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ronald de Groot
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Emma Lim
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian K Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, UK
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud G Nijman
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Marko Pokorn
- University Medical Centre Ljubljana, Department of Infectious Diseases and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Chantal D Tan
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Maria Tsolia
- Second Department of Paediatrics, P. and A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Clementien L Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joany M Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dace Zavadska
- Department of Paediatrics, Children Clinical University Hospital, Rīga Stradiņa Universitāte, Riga, Latvia
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
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6
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Summers A. Diagnostic and treatment dilemmas in well children with petechial rash in the emergency department. Emerg Nurse 2022; 31:e2138. [PMID: 36043329 DOI: 10.7748/en.2022.e2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
This article presents a discussion based on a case study of an eight-month-old boy with petechial rash who presented at the emergency department (ED). Blood tests were obtained and intravenous antibiotics were administered. The patient was admitted to the children's ward and was discharged the next day. It was suspected that the rash was caused by a non-specific viral illness. Non-blanching rashes, such as petechial rash, in well children often lead to diagnostic and treatment dilemmas in the ED. Clinicians fear missing the diagnosis of invasive meningococcal disease, which results in blood tests, cannulation and early administration of antibiotics. Non-blanching rashes have many potential causes and extensive tests and antibiotic treatment may not always be necessary and have the potential to cause harm. A tailored approach to investigate, treat and discharge well children with petechial rash from the ED is advocated.
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Affiliation(s)
- Andriana Summers
- Emergency Department, Airedale General Hospital, Airedale NHS Foundation Trust, Keighley, West Yorkshire, England
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7
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Williams TC, Lyttle MD, Cunningham S, Sinha I, Swann OV, Maxwell-Hodkinson A, Marlow R, Roland D. Study Pre-protocol for "BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study". Wellcome Open Res 2022; 6:120. [PMID: 34458589 PMCID: PMC8378404 DOI: 10.12688/wellcomeopenres.16778.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome. Information be released on a weekly basis and used to support clinical decision making.
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Affiliation(s)
- Thomas C. Williams
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Mark D. Lyttle
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Steve Cunningham
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Ian Sinha
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
| | - Olivia V. Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | | | - Robin Marlow
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Bristol Royal Hospital for Children, Bristol, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- Sapphire Group, Health Sciences, Leicester University, University of Leicester, UK
| | - Paediatric Emergency Research in the UK and Ireland (PERUKI)
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
- University of Liverpool Medical School, Liverpool, UK
- Bristol Royal Hospital for Children, Bristol, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- Sapphire Group, Health Sciences, Leicester University, University of Leicester, UK
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8
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Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational multicenter study. Eur J Pediatr 2022; 181:4199-4209. [PMID: 36178539 PMCID: PMC9649464 DOI: 10.1007/s00431-022-04606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED 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%). CONCLUSION 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. WHAT IS KNOWN • 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. WHAT IS NEW • 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.
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9
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Analysis of Nursing Effect of Children with Henoch-Schonlein Purpura Based on the PDCA Nursing Model. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1736429. [PMID: 34938349 PMCID: PMC8687780 DOI: 10.1155/2021/1736429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/10/2021] [Accepted: 11/20/2021] [Indexed: 11/23/2022]
Abstract
By applying the PDCA model to the care of children with Henoch-Schonlein purpura, the nursing process can be divided into four stages: planning, execution, inspection, and treatment. According to the age characteristics and disease progression of pediatric patients, a complete nursing plan is formulated to efficiently implement the nursing content and improve the nursing effect. This paper studies the application of the PDCA nursing model in the nursing of children with Henoch-Schonlein purpura and statistically analyzes the disappearance of skin rash, joint pain relief, disappearance of urine protein, disappearance of gastrointestinal symptoms, etc. Finally, this paper combines the experiment to evaluate the intervention effect of this nursing model and provides reference for the follow-up care of children with Henoch-Schonlein purpura. From the results of experimental research, it can be known that PDCA nursing can improve the comfort of children with Henoch-Schonlein purpura, shorten the time for symptom disappearance, and speed up the recovery process.
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10
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Waterfield T. Validating BSAC guidance for the management of children with fever and non-blanching rash. THE LANCET. INFECTIOUS DISEASES 2021; 21:1487. [PMID: 34717801 DOI: 10.1016/s1473-3099(21)00623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas Waterfield
- Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast BT97BL, UK.
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11
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Williams TC, Lyttle MD, Cunningham S, Sinha I, Swann OV, Maxwell-Hodkinson A, Marlow R, Roland D. Study Pre-protocol for "BronchStart - The Impact of the COVID-19 Pandemic on the Timing, Age and Severity of Respiratory Syncytial Virus (RSV) Emergency Presentations; a Multi-Centre Prospective Observational Cohort Study". Wellcome Open Res 2021; 6:120. [PMID: 34458589 PMCID: PMC8378404 DOI: 10.12688/wellcomeopenres.16778.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Bronchiolitis (most frequently caused by respiratory syncytial virus; RSV) is a common winter disease predominantly affecting children under one year of age. It is a common reason for presentations to an emergency department (ED) and frequently results in hospital admission, contributing to paediatric units approaching or exceeding capacity each winter. During the SARS-CoV-2 pandemic, the circulation of RSV was dramatically reduced in the United Kingdom and Ireland. Evidence from the Southern Hemisphere and other European countries suggests that as social distancing restrictions for SARS-CoV-2 are relaxed, RSV infection returns, causing delayed or even summer epidemics, with different age distributions. Study question: The ability to track, anticipate and respond to a surge in RSV cases is critical for planning acute care delivery. There is an urgent need to understand the onset of RSV spread at the earliest opportunity. This will influence service planning, to inform clinicians whether the population at risk is a wider age range than normal, and whether there are changes in disease severity. This information is also needed to inform decision on the timing of passive immunisation of children at higher risk of hospitalisation, intensive care admission or death with RSV infection, which is a public health priority. Methods and likely impact: This multi-centre prospective observational cohort study will use a well-established research network (Paediatric Emergency Research in the UK and Ireland, PERUKI) to report in real time cases of RSV infection in children aged under two years, through the collection of essential, but non-identifying patient information. Forty-five centres will gather initial data on age, index of multiple deprivation quintile, clinical features on presentation, and co-morbidities. Each case will be followed up at seven days to identify treatment, viral diagnosis and outcome. Information be released on a weekly basis and used to support clinical decision making.
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Affiliation(s)
- Thomas C. Williams
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Mark D. Lyttle
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Steve Cunningham
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Ian Sinha
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
| | - Olivia V. Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | | | - Robin Marlow
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Bristol Royal Hospital for Children, Bristol, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- Sapphire Group, Health Sciences, Leicester University, University of Leicester, UK
| | - Paediatric Emergency Research in the UK and Ireland (PERUKI)
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
- University of Liverpool Medical School, Liverpool, UK
- Bristol Royal Hospital for Children, Bristol, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- Sapphire Group, Health Sciences, Leicester University, University of Leicester, UK
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Atypical presentation of Neisseria meningitidis serogroup W disease is associated with the introduction of the 2013 strain. Epidemiol Infect 2021; 149:e126. [PMID: 33910672 PMCID: PMC8161285 DOI: 10.1017/s0950268821001035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Since 2015, the incidence of invasive meningococcal disease (IMD) caused by serogroup W (MenW) has increased in Sweden, due to the introduction of the 2013 strain belonging to clonal complex 11. The aim of this study was to describe the clinical presentation of MenW infections, in particular the 2013 strain, including genetic associations. Medical records of confirmed MenW IMD cases in Sweden during the years 1995–2019 (n = 113) were retrospectively reviewed and the clinical data analysed according to strain. Of all MenW patients, bacteraemia without the focus of infection was seen in 44%, bacteraemic pneumonia in 26%, meningitis in 13% and epiglottitis in 8%, gastrointestinal symptoms in 48% and 4% presented with petechiae. Phylogenetic analysis was used for possible links between genetic relationship and clinical picture. The 2013 strain infections, particularly in one cluster, were associated with more severe disease compared with other MenW infections. The patients with 2013 strain infections (n = 68) were older (52 years vs. 25 years for other strains), presented more often with diarrhoea as an atypical presentation (P = 0.045) and were more frequently admitted for intensive care (P = 0.032). There is a risk that the atypical clinical presentation of MenW infections, with predominantly gastrointestinal or respiratory symptoms rather than neck stiffness or petechiae, may lead to delay in life-saving treatment.
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Snelson E, Waterfield T. Testing the limits of pragmatism in children with fever and non-blanching rash. THE LANCET. INFECTIOUS DISEASES 2021; 21:320. [PMID: 33639121 DOI: 10.1016/s1473-3099(20)30936-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Edward Snelson
- Consultant Paediatric Emergency Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Thomas Waterfield
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK.
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