Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

Abstract

Vital signs can help clinicians identify children at risk of serious illness. The NICE guideline for fever in under-fives recommends a routine measurement of temperature, heart rate, capillary refill and respiratory rate in all febrile children visiting the emergency department (ED). This study aims to evaluate the measurement of paediatric vital signs in European EDs, with specific attention to adherence to this NICE guideline recommendation. In a prospective observational study, we included 4560 febrile children under 16 years from the ED of 28 hospitals in 11 European countries (2014-2016). Hospitals were academic (n = 17), teaching (n = 10) and non-teaching (n = 1) and ranged in annual paediatric ED visits from 2700 to 88,000. Fifty-four percent were male, their median age was 2.4 years (IQR 1.1-4.7). Temperature was measured most frequently (97%), followed by capillary refill (86%), heart rate (73%), saturation (56%) and respiratory rate (51%). In children under five (n = 3505), a complete measurement of the four NICE-recommended vital signs was performed in 48% of patients. Children under 1 year of age, those with an urgent triage level and with respiratory infections had a higher likelihood of undergoing complete measurements. After adjustment for these factors, variability between countries remained.

Management of children visiting the emergency department during out-of-office hours: an observational study

“…This results in some missing data, which we dealt with using multiple imputation for vital signs. The proportion of missing data for vital signs was comparable with previous studies 45–47 and varied between the hospitals, which can be expected due to patient mix and differences in local policies.…”

Improving the prioritization of children at the emergency department: Updating the Manchester Triage System using vital signs

“…In our study vital signs were missing in 42% to 52% of the ED visits. This proportion is in line with previous studies reporting on vital signs measurements in the ED [25][26][27]. To deal with the missing values we used a multiple imputation approach to reduce bias [16].…”

Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

“…This poor adherence to recommendations agrees with findings of moderate adherence to other vital sign measurements in febrile children in different European EDs. 38 Strengths of this study include the participation of different EDs in Europe, the detailed data collection and the evaluation of the Shock Index for different definitions of serious illness: 21 38 Patients with BP measurement, however, likely reflect the group in which the Shock Index would potentially be used in clinical practice. Second, we focused our analysis on high Shock Index since in febrile children we expect the combination of tachycardia and hypotension to be valuable.…”