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Febrile children in the Emergency Department: Frequency and predictors of poor outcome
Author(s) -
Long Elliot,
Solan Tom,
Stephens David J.,
Schlapbach Luregn J.,
Williams Amanda,
Tse Wai Chung,
Babl Franz E.
Publication year - 2021
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.15602
Subject(s) - medicine , emergency department , vital signs , mechanical ventilation , organ dysfunction , odds ratio , triage , observational study , emergency medicine , inotrope , renal replacement therapy , life support , retrospective cohort study , intensive care medicine , sepsis , surgery , psychiatry
Aim To evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department. Methods Retrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6‐month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra‐corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver‐operating characteristics curve were calculated for each predictor variable. Results Between Jan‐June 2019, 6217 children met inclusion criteria. Twenty‐seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra‐corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency. Conclusion Poor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.