NHG-Standaard Kinderen met koorts

Berger, M Y; Boomsma, LJ; Albeda, F W; Dijkstra, R H; Graafmans, T A; Laan, J R van der; Lemmen, W H; Oteman, N

doi:10.1007/978-90-313-6614-9_79

Cited by 4 publications

(2 citation statements)

References 87 publications

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“…However, vital signs might act as a red flag for serious infection, as suggested by most recent guidelines. 13 21 The results of our study confirm this assumption.…”

Section: Discussionsupporting

confidence: 81%

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care

et al. 2015

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ObjectiveAcute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population.DesignDiagnostic accuracy study validating a clinical prediction rule.Setting and participantsAcutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department.InterventionPhysicians were asked to score the decision tree in every child.Primary outcome measuresThe outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values.ResultsIn total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%.ConclusionsIn an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out.Trial registration numberNCT02024282.

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“…However, vital signs might act as a red flag for serious infection, as suggested by most recent guidelines. 13 21 The results of our study confirm this assumption.…”

Section: Discussionsupporting

confidence: 81%

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care

et al. 2015

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“…6,7 Consequently, practice guidelines are mainly based on consensus of expert opinion and scientific evidence collected from secondary and tertiary emergency care studies. 8,9 To complement practice guidelines, clinical prediction rules (CPRs) could be powerful tools to improve clinical decision making on the basis of combinations of clinical signs and symptoms. 10 However, most published CPRs for serious infections have been developed predominantly at hospital emergency departments (EDs), [11][12][13] with the lack of external validation in low-prevalence populations hampering their implementation in primary care practice.…”

Section: Introductionmentioning

confidence: 99%

Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

Ierland

Elshout²,

Berger

et al. 2015

Br J Gen Pract

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Study setting and selection of patientsThe out-of-hours healthcare system in the Netherlands and data collection of this study have been published previously. 15 In summary, all contacts of children <16 years that had taken place at five GP cooperatives (GPCs) of the Rotterdam Rijnmond-district (collaboration of >250 GP-practices) between March 2008 and February 2009 were selected. Eligible contacts were those concerning children who had a face-to-face consultation with the GP and reported fever as the reason for contact, had fever within the 24 hours before contact, or had a (rectal or tympanic) temperature >38˚C measured at the GPC. Re-contacts for the same problem within 7 days of the initial presentation were excluded from the main analyses.

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