Duration of fever and serious bacterial infections in children: a systematic review

Background: Parents of febrile children frequently contact primary care. Longer duration of fever has been related to increased risk for serious bacterial infections (SBI). However, the evidence for this association remains controversial. We assessed the predictive value of duration of fever for SBI. Methods: Studies from MEDLINE, Embase and Cochrane databases (from January 1991 to December 2009) were retrieved. We included studies describing children aged 2 months to 6 years in countries with high Haemophilus influenzae type b vaccination coverage. Duration of fever had to be studied as a predictor for serious bacterial infections. Results: Seven studies assessed the association between duration of fever and serious bacterial infections; three of these found a relationship. Conclusion: The predictive value of duration of fever for identifying serious bacterial infections in children remains inconclusive. None of these seven studies was performed in primary care. Studies evaluating the duration of fever and its predictive value in children in primary care are required

Telefonische triage van kinderen met koorts: Wat bepaalt of er een consult volgt?

Inleiding Ernstige infecties komen weliswaar weinig voor bij kinderen, maar wanneer ouders de huisartsenpost bellen omdat hun kind koorts heeft, zal de huisarts dat kind vaak toch persoonlijk willen zien. De bestaande richtlijnen voor triage zijn echter bedoeld voor kinderen die al verwezen zijn, en dus niet per se geschikt voor gebruik op de huisartsenpost. Wij onderzochten welke factoren bij de triage op de huisartsenpost van invloed zijn op de uiteindelijke contactvorm.  Methode Assistentes op de huisartsenpost in Rotterdam-Zuid vulden een korte vragenlijst in wanneer ouders opbelden omdat hun kind (tussen drie maanden en zes jaar oud) koorts had. De assistentes gingen ook na hoe bezorgd de ouders waren. Wij onderzochten of de telefonische triage uiteindelijk leidde tot een telefonisch advies, een consult op de post of een huisbezoek. Dekinderen waarom het ging, verdeelden we in twee leeftijdsgroepen: jonger dan anderhalf jaar en ouder dan anderhalf jaar. Voor beide leeftijdsgroepen ontwikkelden we een prognostisch model.  Resultaten Op de huisartsenpost meldden zich 422 kinderen met koorts. Van hen kwam 73% uiteindelijk naar de post voor een consult. De jongste leeftijdsgroep maakte de grootste kans op een consult wanneer de ouders meldden dat hun kind minder dronk en benauwd was. Bij kinderen ouder dan anderhalf jaar was die kans het grootst wanneer de koorts langer dan twee dagen duurde, wanneer het kind volgens de ouders suf was of wanneer het volgens de ouders een bleke, grauwe of gevlekte huid had. Bij alle kinderen met deze alarmsymptomen verliep de triage conform de richtlijn. Kinderen die géén alarmsymptomen hadden, werden vaker ingepland voor een consult als de ouders zich zorgen maakten, ongeacht hun leeftijd. Conclusie De assistentes op de huisartsenpost volgden in grote lijnen de richtlijn. Verrassend genoeg bleek dat de meeste kinderen volgens de ouders alarmsymptomen hadden, hetgeen de validiteit van het vragen naar deze symptomen aan de ouders twijfelachtig maakt

Respiratory virus infections in febrile children presenting to a general practice out-of-hours service

Background: Fever is common in young children and is assumed to be frequently caused by viral infections. Objectives: To document respiratory viruses in children with fever presenting at a general practice out-of-hours service (OHS), evaluate presenting symptoms in febrile children with a virus infection, and examine the association between antibiotic prescription and the presence of a viral infection. Methods: Nasopharyngeal swabs were obtained to detect respiratory viruses in non-hospitalized children aged >= three months to six years presenting with fever at an OHS. Symptoms were assessed using physical examinations and questionnaires. Logistic regression analysis was used to reveal associations between symptoms or diagnoses, and the presence of at least one virus Results: In total 257 nasopharyngeal swabs were obtained in 306 eligible children; 53% of these children were infected by at least one virus. The most frequently detected viruses were adenovirus (10.9%), RSV type A (10.5%) and PIV type 1 (8.6%). Cough (OR 2.6; 95% CI: 1.4-4.6) and temperature >= 38.0 degrees C (OR 2.1; 95% CI: 1.3-3.5) were independent predictors of the presence of a virus, but the discriminative ability was low (AUC 0.64; 95% CI: 0.58-0.71). Antibiotic prescription rate was 37.3%. In 57.4% of children with an antibiotic prescription, a virus was found. Conclusion: In over 50% of all febrile children presenting at an OHS, a virus was found. Antibiotic prescription rate was high and not associated to the outcome of viral testing

Respiratory virus infections in febrile children presenting to a general practice out-of-hours service

Background: Fever is common in young children and is assumed to be frequently caused by viral infections. Objectives: To document respiratory viruses in children with fever presenting at a general practice out-of-hours service (OHS), evaluate presenting symptoms in febrile children with a virus infection, and examine the association between antibiotic prescription and the presence of a viral infection. Methods: Nasopharyngeal swabs were obtained to detect respiratory viruses in non-hospitalized children aged ≥ three months to six years presenting with fever at an OHS. Symptoms were assessed using physical examinations and questionnaires. Logistic regression analysis was used to reveal associations between symptoms or diagnoses, and the presence of at least one virus Results: In total 257 nasopharyngeal swabs were obtained in 306 eligible children; 53% of these children were infected by at least one virus. The most frequently detected viruses were adenovirus (10.9%), RSV type A (10.5%) and PIV type 1 (8.6%). Cough (OR 2.6; 95% CI: 1.4-4.6) and temperature ≥ 38.0°C (OR 2.1; 95% CI: 1.3-3.5) were independent predictors of the presence of a virus, bu

Triage of febrile children at a GP cooperative: determinants of a consultation

Background Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. Aim To investigate the determinants related to the outcome of triage in febrile children. Design of study Cross-sectional study. Setting Dutch GP cooperative. Method Receptionists filled out a triage questionnaire when parents called regarding their febrile child (aged between 3 months and 6 years) and estimated the level of concern of the parents. The outcome was either telephone advice, a consultation, or a home visit. Children were divided in subgroups based on age = 18 months, and prognostic models for a consultation were constructed. Results Of 422 children, 73% were seen by a GP. Children aged = 18 months, a duration of fever of >= 3 days, drowsiness, or a pale, ashen, or mottled skin were predictors of consultation. Children with alarm symptoms were seen according to the guideline. In both subgroups, children without alarm symptom's were more likely to be seen when their parents were concerned. Conclusion The available guideline was followed to a large extent at a GP cooperative. Because, surprisingly, most children were reported to have alarm symptoms, the validity of the triage questions asking parents about alarm symptoms is questionable