PhD Defence J.S. (Josephine) van de Maat

Fever and respiratory tract infections are common in children and the main reason to be brought to the emergency department (ED). In this thesis we studied how to improve decisions on management of these children in the ED. We showed that across European ED’s high unnecessary variability exists in the number of children receiving antibiotics in the ED, in particular for respiratory tract infections. In eight Dutch hospitals we implemented a clinical decision rule (Feverkidstool) to guide doctors in antibiotic prescription in the ED. This did not lead to an overall reduction in antibiotic prescriptions, but was safe and improved targeting of antibiotics towards children at high risk of a pneumonia. The Feverkidstool was cost-saving, due to less hospital admissions and less parental absenteeism from paid work. The addition of a new blood test to the Feverkidstool increased the ability to distinguish self-limiting viral infections from bacterial infections needing antibiotic treatment. We also studied parents, since they are also important decision makers during the disease course of their child. We found that parents are often concerned based on an unspecific parental intuition. It is crucial that health workers take this feeling seriously, and provide clear discharge information on how parents can manage their child at home and when to seek medical attention. We developed a discharge information package on fever and pneumonia. Parents reported increased knowledge and confidence in caring for their child with fever after consulting the information package.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall of the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.