Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational multicenter study
Chantal Tan, Eline E. P. L. van der Walle, Clementien L. Vermont, Ulrich von Both, Enitan D. Carrol, Irini Eleftheriou, Marieke Emonts, Michiel van der Flier, Ronald de Groot, Jethro Herberg, Benno Kohlmaier, Michael Levin, Emma Lim, Ian Maconochie, Federico Martinón‐Torres, Ruud Nijman, Marko Pokorn, Irene Rivero‐Calle, Μαρία Τσολιά, Shunmay Yeung, Werner Zenz, Dace Zavadska, Henriëtte A. Moll, Michael Levin, Aubrey J. Cunnington, Tisham De, Jethro Herberg, Myrsini Kaforou, Victoria Wright, Lucas Baumard, Evangelos Bellos, Giselle D’Souza, Rachel Galassini, Dominic Habgood-Coote, Shea Hamilton, Clive Hoggart, Sara Hourmat, Heather Jackson, Ian Maconochie, Stephanie Menikou, Naomi Lin, Samuel Nichols, Ruud Nijman, Ivonne Pena Paz, Priyen Shah, Ching‐Fen Shen, Ortensia Vito, Clare Wilson, Amina Abdulla, Ladan Ali, Sarah Darnell, Rikke Jørgensen, Sobia Mustafa, Salina Persand, Molly M. Stevens, Eunjung Kim, Benjamin C. Pierce, Katy Fidler, Julia Dudley, Vivien Richmond, Emma Tavliavini, Hsiao‐Sheng Liu, Shih-Min Wang, Federico Martinón‐Torres, Antonio Salas, Fernando Álvez González, Cristina Balo Farto, Ruth Barral‐Arca, María Barreiro Castro, Xabier Bello, Mirian Ben García, Sandra Carnota, Miriam Cebey‐López, María José Currás-Tuala, Carlos Durán Suárez, Luisa García Vicente, Alberto Gómez‐Carballa, José Gómez Rial, Pilar Leboráns Iglesias, Federico Martinón‐Torres, Nazareth Martinón-Torres, José María Martinón Sánchez, Belén Mosquera Pérez, Jacobo Pardo‐Seco, Lidia Piñeiro Rodríguez, Sara Pischedda, Sara Rey Vázquez, Irene Rivero‐Calle, Carmen Rodrı́guez-Tenreiro, Lorenzo Redondo-Collazo, Miguel Sadiki Ora, Antonio Salas, Sonia Serén Fernández, Cristina Serén Trasorras, Marisol Vilas Iglesias, Dace Zavadska, Anda Balode, Arta Bārzdiņa, Dãrta Deksne, Dace Gardovska
Abstract
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.