Recommendations for 5 key steps in managing fever in children and parental concordance with recommendations by healthcare professional consulted.

<p>^a Concordance with recommendations of our study.</p><p>^b For patients with fever for ≥24 hr (n = 2,559).</p

Summary of actors associated with high concordance with recommendations for the 5 key steps in managing fever symptoms in children (see details including confidence intervals in appendix 2 to 6).

<p>^a Adjusted odds ratio (aOR) for patient- or HP-level variables with P<0.1 on univariate analysis.</p><p>^b At the patient-level, no association was found between any of the 5 steps and the child's gender and birth order.</p><p>P≤0.05;</p><p>^c At the HP-level, no association was found between any of the 5 steps and practice location.</p><p>^d HP, healthcare professional;</p><p>^e GP, general practitioner.</p

Patient characteristics.

<p>CI: confidence interval 95%.</p><p>IQR: interquartile range.</p><p>GHD: growth hormone deficiency.</p><p>MPD: multiple pituitary deficiencies.</p><p>SDS: standard deviation score.</p><p>ZS: Z-score.</p

Individual analysis of auxological GHRS criteria.

<p>*over 1 year.</p><p>**over 1 year in children older than 2 years of age.</p><p>***over 2 years.</p><p>CI: confidence interval 95%.</p><p>IQR: interquartile range.</p><p>SDS: standard deviation score.</p

Healthcare professionals’ practices for fever in children and concordance with recommendations.

<p>*no. of children recruited.</p><p>AAP, American Academy of Pediatrics; NICE, UK National Institute for Health and Clinical Excellence; Afssaps, French Drug Agency; CPS, Canadian Paediatric Society</p><p>^μ Percentage calculated on available data (n’)</p><p>^a Recommended physical treatments in our study.</p><p>^b Increase heating, not aerate the room, use a ventilator, dress the child, use a wet sponge, humidify the room.</p><p>^c Concordance with recommendations of our study.</p><p>Healthcare professionals’ practices for fever in children and concordance with recommendations.</p

Stability of serum ferritin measured by immunoturbidimetric assay after storage at -80°C for several years

<div><p>Background</p><p>Iron deficiency (ID) may impair long-term neurological development when it occurs in young infants. In cohort studies, it is sometimes necessary to evaluate ID with sera kept frozen for several years. To assess ID, learned societies recommend measuring serum ferritin (SF) level combined with C-reactive protein level. The long-term stability of C-reactive protein in frozen samples is well established but not ferritin.</p><p>Methods</p><p>We measured SF level (immunoturbidimetric assay; in micrograms per liter) immediately after collection from 53 young adults recruited and followed-up in Porto, Portugal, from 2011 to 2013 (SF₁), and then, in 2016 in two aliquots kept frozen at– 80°C for 3 to 5 years: one without (SF_2A) and one with (SF_2B) intermediate thawing in 2014. We compared SF₁ to SF_2A then SF_2B; statistical agreement was evaluated by the Bland and Altman method and the effect of intermediate thawing by regression modelling.</p><p>Results</p><p>Mean SF_2A–SF₁ and SF_2B–SF₁ differences were -2.1 (SD 7.0) and 48.9 (SD 66.9). Values for Bland and Altman 95% limits of agreement were higher for the comparison of SF_2B and SF₁ than SF_2A and SF₁: -82.2 to 179.9 and -15.8 to 11.8, respectively; the effect of thawing was highly significant (p <0.001).</p><p>Conclusions</p><p>Agreement between SF values before and after 3 to 5 years of constant freezing at -80°C was in a generally accepted range, which supports the hypothesis of ferritin’s stability at this temperature for a long period. In long-term storage by freezing, intermediate thawing induced a major increase in values.</p></div

Predictive performance of procalcitonin (PCT) level in clinical response to beta-lactam treatment.

<p>PCT thresholds are in ng/mL.</p><p>Numbers in square brackets are 95% confidence intervals.</p><p>Abbreviations: PPV, positive predictive value; NPV, negative predictive value; PLR, positive likelihood ratio, NLR, negative likelihood ratio.</p

Distribution of procalcitonin (PCT) level according to clinical response to beta-lactam treatment. The short, bold, horizontal lines are the median for each group.

<p>Distribution of procalcitonin (PCT) level according to clinical response to beta-lactam treatment. The short, bold, horizontal lines are the median for each group.</p

Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective, multicenter study

<div><p>Background</p><p>There is controversy whether physicians can rely on signs and symptoms to select children with pharyngitis who should undergo a rapid antigen detection test (RADT) for group A streptococcus (GAS). Our objective was to evaluate the efficiency of signs and symptoms in selectively testing children with pharyngitis.</p><p>Materials and methods</p><p>In this multicenter, prospective, cross-sectional study, French primary care physicians collected clinical data and double throat swabs from 676 consecutive children with pharyngitis; the first swab was used for the RADT and the second was used for a throat culture (reference standard). We developed a logistic regression model combining signs and symptoms with GAS as the outcome. We then derived a model-based selective testing strategy, assuming that children with low and high calculated probability of GAS (<0.12 and >0.85) would be managed without the RADT. Main outcomes and measures were performance of the model (<i>c</i>-index and calibration) and efficiency of the model-based strategy (proportion of participants in whom RADT could be avoided).</p><p>Results</p><p>Throat culture was positive for GAS in 280 participants (41.4%). Out of 17 candidate signs and symptoms, eight were retained in the prediction model. The model had an optimism-corrected <i>c</i>-index of 0.73; calibration of the model was good. With the model-based strategy, RADT could be avoided in 6.6% of participants (95% confidence interval 4.7% to 8.5%), as compared to a RADT-for-all strategy.</p><p>Conclusions</p><p>This study demonstrated that relying on signs and symptoms for selectively testing children with pharyngitis is not efficient. We recommend using a RADT in all children with pharyngitis.</p></div

Predictor variables included in the multivariable model.

<p>Predictor variables included in the multivariable model.</p