Febrile children with comorbidities at the emergency department — a multicentre observational study

被引:0
作者
Dorine M. Borensztajn
Nienke N. Hagedoorn
Enitan D. Carrol
Ulrich von Both
Marieke Emonts
Michiel van der Flier
Ronald de Groot
Jethro Herberg
Benno Kohlmaier
Michael Levin
Emma Lim
Ian K. Maconochie
Federico Martinon-Torres
Ruud G. Nijman
Marko Pokorn
Irene Rivero-Calle
Maria Tsolia
Fabian J. S. van der Velden
Clementien Vermont
Dace Zavadska
Werner Zenz
Joany M. Zachariasse
Henriette A. Moll
机构
[1] Erasmus MC-Sophia Children’s Hospital,Department of General Paediatrics
[2] University of Liverpool,Institute of Infection, Veterinary and Ecological Sciences
[3] Alder Hey Children’s NHS Foundation Trust,Department of Infectious Diseases
[4] Liverpool Health Partners,Division of Paediatric Infectious Diseases
[5] Dr. Von Hauner Children’s Hospital,DZIF
[6] University Hospital,Translational and Clinical Research Institute
[7] Ludwig-Maximilians-University (LMU),Department of Paediatric Infectious Diseases and Immunology
[8] German Centre for Infection Research,Department of Paediatric Infectious Diseases and Immunology
[9] Partner Site Munich,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine
[10] Great North Children’s Hospital,Section of Paediatric Infectious Diseases
[11] Paediatric Immunology,Department of General Paediatrics
[12] Infectious Diseases & Allergy,Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP)
[13] Newcastle Upon Tyne Hospitals NHS Foundation Trust,Department of Infectious Diseases
[14] Newcastle University,Second Department of Paediatrics
[15] NIHR Newcastle Biomedical Research Centre Based at Newcastle Upon Tyne Hospitals NHS Trust and Newcastle University,Department of Pediatric Infectious Diseases & Immunology
[16] Amalia Children’s Hospital,Department of Pediatrics
[17] Wilhelmina Children’s Hospital,undefined
[18] University Medical Centre Utrecht,undefined
[19] Radboud Institute for Molecular Sciences,undefined
[20] Radboud University Medical Centre,undefined
[21] Radboud Center for Infectious Diseases,undefined
[22] Imperial College of Science,undefined
[23] Technology and Medicine,undefined
[24] Medical University of Graz,undefined
[25] Hospital Clínico Universitario de Santiago de Compostela,undefined
[26] University Medical Centre Ljubljana,undefined
[27] Univerzitetni Klinični Center,undefined
[28] National and Kapodistrian University of Athens,undefined
[29] P. and A. Kyriakou Children’s Hospital,undefined
[30] Erasmus MC-Sophia Children’s Hospital,undefined
[31] Children Clinical University Hospital,undefined
来源
European Journal of Pediatrics | 2022年 / 181卷
关键词
Chronic disease; Comorbidity; Fever; Infectious diseases; Emergency care;
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学科分类号
摘要
We aimed to describe characteristics and management of children with comorbidities attending European emergency departments (EDs) with fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last > 1 year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, p < 0.001), had an ED-Paediatric Early Warning Score of > 15 (22 versus 12%, p < 0.001), or a C-reactive protein > 60 mg/l (aOR 1.4 (95%CI 1.3–1.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2–3.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1–2.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1–2.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8–7.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7–2.0), including sepsis/meningitis (aOR 4.6, 95%CI 3.2–6.7). Children most at risk for sepsis/meningitis were children with malignancy/immunodeficiency (aOR 14.5, 8.5–24.8), while children with psychomotor delay/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1–6.9) or PICU admission (aOR 9.7, 6.1–15.5).
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页码:3491 / 3500
页数:9
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