PhD defence D.M. (Dorine) Borensztajn

Summary:

Children with fever form an important part of all ED visits. It is an enormous challenge for physicians to distinguish between self-limiting viral infections, and bacterial infections, which require treatment with antibiotics. If not treated timely, these can have disastrous consequences, such as mortality. However, unnecessary diagnostics and treatment, are expensive and invasive and prolong time spent at the ED.

This dissertation, which studied data of 140,000 European children, aims to improve the care for children at the ED by identifying areas with wide practice variation, by identifying children at risk for a complicated disease course such as intensive care admission and by improving patient flow.

We found large differences across Europe in factors influencing care, such as immunization schedules, physician educational background and guidelines. Furthermore, we found large differences in diagnostics, treatment and admissions of children that attended the ED, regardless of illness severity. Lastly, we found that children that attended the ED at night were more ill than children attending the ED during the day, emphasizing the importance of 24/7 adequate emergency care for children.

Both adolescents and children with comorbidities were more likely to have bacterial infections. Children with comorbidities form a heterogeneous group, with some children having an increased risk of bacterial infections, while others have an increased risk of a complicated disease course, regardless of the cause of the fever.

Finally, we developed a prediction model, that can predict hospital admission upon arrival at the ED. A second prediction model identified children at risk for a severe course. These prediction models can shorten time spent at the ED and can be used to improve safety-netting advice.