Introduction
Materials and methods
Study design
Ethics statement
Study population and setting
Data collection
Definitions
Data quality and missing data
Data analysis
Results
Level of complexity, n = 38,110 | |
---|---|
None | 32,204 (84.5) |
Non-complex comorbidity | 4228 (11.1) |
Complex comorbidity | 1678 (4.4) |
Type of comorbidity, n = 5906* | |
Pulmonary | 1414 (23.9) |
Neurologic | 1108 (18.8) |
Prematurity | 1024 (17.3) |
Psychomotor delay | 809 (13.7) |
Urology/nephrology | 712 (12.1) |
Cardiac | 623 (10.5) |
Immunodeficiency | 508 (8.6) |
Malignancy | 297 (5.0) |
Gastrointestinal | 227 (3.8) |
Hematologic | 298 (5.0) |
Metabolic | 222 (3.8) |
Other | 460 (7.8) |
No comorbidity N = 32,204 N (%) | Comorbidity (any)a N = 5906 N (%) | No comorbidity versus any comorbidity P | Non-complex comorbiditya N = 4228 N (%) | Complex comorbiditya N = 1678 N (%) | |
---|---|---|---|---|---|
Male | 17,424 (54) | 3532 (59%) | < 0.001 | 2477 (59) | 1012 (60) |
Age in years, median (IQR) | 2.6 (1.3–5.3) | 3.7 (1.6–7.7) | < 0.001 | 3.5 (1.5–7.1) | 4.4 (2.0–9.2) |
Duration of fever | < 0.001 | ||||
< 24 h | 10,528 (35) | 2301 (44) | 1573 (41) | 728 (50) | |
24–48 h | 9935 (33) | 1463 (28) | 1101 (29) | 362 (25) | |
> 48 h | 9722 (33) | 1505 (29) | 1123 (30) | 382 (26) | |
Previous ED visit | 2427 (7.5) | 688 (12%) | < 0.001 | 444 (10) | 244 (15) |
Referral | < 0.001 | ||||
Self | 18,377 (59) | 2656 (47) | 2038 (51) | 618 (39) | |
GP/private paediatrician | 5373 (17) | 984 (17) | 759 (19) | 225 (14) | |
Emergency medical service | 4826 (15) | 718 (13) | 538 (13) | 180 (11) | |
Other | 2773 (8.8) | 1250 (22) | 698 (17) | 552 (35) | |
Triage urgency | < 0.001 | ||||
High | 10,071 (32) | 2988 (53) | 1881 (46) | 1107 (69) | |
Vital signsb and PEWS | |||||
Tachycardia | 7736 (24) | 1708 (29) | < 0.001 | 1135 (27) | 573 (34) |
Tachypnoea | 4377 (14) | 1200 (20) | < 0.001 | 804 (19.0) | 396 (24) |
Hypoxia, oxygen saturation < 95% | 572 (1.8) | 273 (4.6) | < 0.001 | 176 (4.2) | 97 (5.8) |
Prolonged capillary refill ≥ 3 s | 336 (1.2) | 86 (1.7) | < 0.05 | 51 (1.4) | 35 (2.6) |
ED-PEWS < 6 | 6834 (21) | 978 (17) | < 0.001 | 742 (17) | 236 (14) |
ED-PEWS ≥ 15 | 3962 (12) | 1299 (22) | < 0.001 | 858 (20) | 441 (27) |
NICE “red traffic lights” (alarming signs) | |||||
Ill appearance | 4918 (16) | 1063 (20) | < 0.001 | 747 (19) | 316 (22) |
Increased work of breathing | 2343 (8.3) | 870 (18) | < 0.001 | 572 (16) | 298 (22) |
Rash: petechiae/non-blanching | 968 (3.0) | 130 (2.2) | < 0.05 | 99 (2.3) | 31 (1.8) |
Decreased consciousness | 123 (0.4) | 77 (1.3) | < 0.001 | 37 (0.9) | 40 (2.5) |
Meningeal signs | 109 (0.4) | 27 (0.5) | 0.064 | 17 (0.4) | 10 (0.7) |
Status epilepticus | 33 (0.1) | 31 (0.5) | < 0.001 | 12 (0.3) | 19 (1.2) |
Focal neurology | 72 (0.2) | 58 (1.1) | < 0.001 | 25 (0.6) | 33 (2.4) |
Disposition and therapy | |||||
Admission | 7499 (23) | 2136 (36) | < 0.001 | 1360 (32) | 776 (46) |
PICU admission | 76 (0.2) | 79 (1.3) | < 0.001 | 37 (0.9) | 42 (2.5) |
ILSI | 385 (1.2) | 253 (4.3) | < 0.001 | 121 (2.9) | 132 (7.9) |
Patient characteristics
Clinical management
Multivariablea | |
---|---|
Diagnostic tests | |
Any blood test | 2.0 (1.9–2.2) |
CRP performed | 2.0 (1.8–2.1) |
CRP > 60 mg/l | 1.4 (1.3–1.6) |
Imaging | 1.6 (1.5–1.7) |
Blood cultures | 3.0 (2.7–3.3) |
Blood cultures positive | 2.3 (1.6–3.3) |
Extensive testingb | 1.6 (1.4–1.8) |
Therapy | |
ILSI | 2.7 (2.2–3.3) |
Oxygen therapy | 4.9 (4.2–5.7) |
Any antibiotics | 1.6 (1.5–1.7) |
Intravenous antibiotics | 2.3 (2.1–2.5) |
Disposition | |
Any admission | 2.2 (2.1–2.4) |
PICU admission | 5.5 (3.8–7.9) |
Admission with an intervention | 2.2 (2.0–2.4) |