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Borensztajn DM, Hagedoorn NN, Carrol ED, von Both U, Dewez JE, Emonts M, van der Flier M, de Groot R, Herberg J, Kohlmaier B, Lim E, Maconochie IK, Martinon-Torres F, Nieboer D, Nijman RG, Oostenbrink R, Pokorn M, Calle IR, Strle F, Tsolia M, Vermont CL, Yeung S, Zavadska D, Zenz W, Levin M, Moll HA. A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children. Lancet Reg Health Eur 2021; 8:100173. [PMID: 34557857 PMCID: PMC8454797 DOI: 10.1016/j.lanepe.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods The MOFICHE study prospectively collected data on febrile children (0-18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculating the area under the receiver operating curve (AUC). Findings Of 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84).The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likelihood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predictive value 0..95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90- 0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use. Interpretation Patient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow. Funding European Union, NIHR, NHS.
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Affiliation(s)
- Dorine M Borensztajn
- Erasmus MC Sophia Children's Hospital, Department of General Paediatrics, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Nienke N Hagedoorn
- Erasmus MC Sophia Children's Hospital, Department of General Paediatrics, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Enitan D Carrol
- University of Liverpool, Institute of Infection and Global Health, Liverpool, United Kingdom.,Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.,Liverpool Health Partners, First Floor, Science Park, Mount Pleasant, Liverpool L3 5TF
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, university hospital, Ludwig, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Juan Emmanuel Dewez
- London School of Hygiene and Tropical Medicine, Faculty of Tropical and Infectious Disease, London, 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.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Westgate Rd, Newcastle upon Tyne NE4 5PL, United Kingdom.,Translational and Clinical Research Institute, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.,Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, the Netherlands.,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ronald de Groot
- Stichting Katholieke Universiteit, Radboudumc Nijmegen, The Netherlands
| | - Jethro Herberg
- Imperial College of Science, Technology and Medicine, Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, London, United Kingdom.,Department of paediatric Accident and Emergency, St Mary's hospital - Imperial College NHS Healthcare Trust
| | - Benno Kohlmaier
- Medical University of Graz, Department of General Paediatrics, Graz, Austria
| | - 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, Newcastle University, Newcastle upon Tyne, UK
| | - Ian K Maconochie
- Imperial College of Science, Technology and Medicine, Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, London, United Kingdom.,Department of paediatric Accident and Emergency, St Mary's hospital - Imperial College NHS Healthcare Trust
| | - Federico Martinon-Torres
- Hospital Clínico Universitario de Santiago de Compostela, Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Santiago de Compostela, Spain
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Ruud G Nijman
- Imperial College of Science, Technology and Medicine, Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, London, United Kingdom.,Department of paediatric Accident and Emergency, St Mary's hospital - Imperial College NHS Healthcare Trust
| | - Rianne Oostenbrink
- Erasmus MC Sophia Children's Hospital, Department of General Paediatrics, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Marko Pokorn
- University Medical Centre Ljubljana, Univerzitetni Klinični Centre, Department of Infectious Diseases, Ljubljana, Slovenia
| | - Irene Rivero Calle
- Hospital Clínico Universitario de Santiago de Compostela, Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Santiago de Compostela, Spain
| | - Franc Strle
- University Medical Centre Ljubljana, Univerzitetni Klinični Centre, Department of Infectious Diseases, Ljubljana, Slovenia
| | - 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 & immunology, Rotterdam, the Netherlands
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, Faculty of Tropical and Infectious Disease, London, United Kingdom
| | - Dace Zavadska
- Rīgas Stradiņa Universitāte, Department of Paediatrics; Children clinical university hospital, Riga, Latvia
| | - Werner Zenz
- Medical University of Graz, Department of General Paediatrics, Graz, Austria
| | - Michael Levin
- Imperial College of Science, Technology and Medicine, Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Faculty of Medicine, London, United Kingdom
| | - Henriette A Moll
- Erasmus MC Sophia Children's Hospital, Department of General Paediatrics, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
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