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Tan CD, el Ouasghiri S, von Both U, Carrol ED, 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, Vermont CL, Zenz W, Zavadska D, Moll HA, Zachariasse JM. Sex differences in febrile children with respiratory symptoms attending European emergency departments: An observational multicenter study. PLoS One 2022; 17:e0271934. [PMID: 35921337 PMCID: PMC9348645 DOI: 10.1371/journal.pone.0271934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To assess sex differences in presentation and management of febrile children with respiratory symptoms attending European Emergency Departments. Design and setting An observational study in twelve Emergency Departments in eight European countries. Patients Previously healthy children aged 0–<18 years with fever (≥ 38°C) at the Emergency Department or in the consecutive three days before Emergency Department visit and respiratory symptoms were included. Main outcome measures The main outcomes were patient characteristics and management defined as diagnostic tests, treatment and admission. Descriptive statistics were used for patient characteristics and management stratified by sex. Multivariable logistic regression analyses were performed for the association between sex and management with adjustment for age, disease severity and Emergency Department. Additionally, subgroup analyses were performed in children with upper and lower respiratory tract infections and in children below five years. Results We included 19,781 febrile children with respiratory symptoms. The majority were boys (54%), aged 1–5 years (58%) and triaged as low urgent (67%). Girls presented less frequently with tachypnea (15% vs 16%, p = 0.002) and increased work of breathing (8% vs 12%, p<0.001) compared with boys. Girls received less inhalation medication than boys (aOR 0.82, 95% CI 0.74–0.90), but received antibiotic treatment more frequently than boys (aOR 1.09, 95% CI 1.02–1.15), which is associated with a higher prevalence of urinary tract infections. Amongst children with a lower respiratory tract infection and children below five years girls received less inhalation medication than boys (aOR 0.77, 95% CI 0.66–0.89; aOR 0.80, 95% CI 0.72–0.90). Conclusions Sex differences concerning presentation and management are present in previously healthy febrile children with respiratory symptoms presenting to the Emergency Department. Future research should focus on whether these differences are related to clinicians’ attitudes, differences in clinical symptoms at the time of presentation and disease severity.
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Affiliation(s)
- Chantal D. Tan
- Erasmus MC-Sophia Children’s Hospital, Department of General Paediatrics, Rotterdam, The Netherlands
| | - Soufiane el Ouasghiri
- Erasmus MC-Sophia Children’s Hospital, Department of General Paediatrics, Rotterdam, The Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munchen, Germany
- German Centre for Infection Research, DZIF, Partner site Munich, Munchen, Germany
| | - Enitan D. Carrol
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Marieke Emonts
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - 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, Amalia Children’s Hospital, 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, United Kingdom
| | - Benno Kohlmaier
- Medical University of Graz, Department of General Paediatrics, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College, London, United Kingdom
| | - Emma Lim
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Department of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, United Kingdom
| | - Federico Martinon-Torres
- Hospital Clínico Universitario de Santiago de Compostela. Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Santiago de Compostela, Spain
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College, London, United Kingdom
| | - Marko Pokorn
- University Medical Centre Ljubljana, Department of Infectious Diseases and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Hospital Clínico Universitario de Santiago de Compostela. Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Santiago de Compostela, Spain
| | - Maria Tsolia
- National and Kapodistrian University of Athens, Second Department of Paediatrics, P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Clementien L. Vermont
- Erasmus MC-Sophia Children’s Hospital, Department of Paediatric Infectious diseases and Immunology, Rotterdam, The Netherlands
| | - Werner Zenz
- Medical University of Graz, Department of General Paediatrics, Graz, Austria
| | - Dace Zavadska
- Rīgas Stradiņa universitāte, Department of Paediatrics, Children clinical university hospital, Riga, Latvia
| | - Henriette A. Moll
- Erasmus MC-Sophia Children’s Hospital, Department of General Paediatrics, Rotterdam, The Netherlands
| | - Joany M. Zachariasse
- Erasmus MC-Sophia Children’s Hospital, Department of General Paediatrics, Rotterdam, The Netherlands
- * E-mail:
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