Περίληψη:
Background: Prolonged Emergency Department (ED) stay causes crowding and
negatively impacts quality of care. We developed and validated a
prediction model for early identification of febrile children with a
high risk of hospitalisation in order to improve ED flow. Methods: The
MOFICHE study prospectively collected data on febrile children (0-18
years) presenting to 12 European EDs. A prediction models was
constructed using multivariable logistic regression and included patient
characteristics available at triage. We determined the discriminative
values of the model by calculat-ing the area under the receiver
operating curve (AUC). Findings: Of 38,424 paediatric encounters, 9,735
children were admitted to the ward and 157 to the PICU. The prediction
model, combining patient characteristics and NICE alarming, yielded an
AUC of 0.84 (95%CI 0.83-0.84). The model performed well for a rule-in
threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive
likeli-hood ratio 15.1 (95%CI 13.4-17.1), positive predictive value
0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity
95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI
0.14-0.16), negative predic-tive value 0..95 (95%CI 0.95-9.96)).
Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI
0.90-0.93). The model performed well for identifying children needing
PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was
developed to facilitate clinical use. Interpretation: Patient
characteristics and NICE alarming signs available at triage can be used
to identify febrile children at high risk for hospitalisation and can be
used to improve ED flow. Funding: European Union, NIHR, NHS. (c) 2021
The Author(s). Published by Elsevier Ltd. This is an open access article
under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Συγγραφείς:
Borensztajn, Dorine M.
Hagedoorn, Nienke N.
Carrol, Enitan D.
and von Both, Ulrich
Dewez, Juan Emmanuel
Emonts, Marieke and
van der Flier, Michiel
de Groot, Ronald
Herberg, Jethro and
Kohlmaier, Benno
Lim, Emma
Maconochie, Ian K. and
Martinon-Torres, Federico
Nieboer, Daan
Nijman, Ruud G. and
Oostenbrink, Rianne
Pokorn, Marko
Rivero Calle, Irene
Strle,
Franc
Tsolia, Maria
Vermont, Clementien L.
Yeung, Shunmay
and Zavadska, Dace
Zenz, Werner
Levin, Michael
Moll,
Henriette A.
PERFORM Consortium Personalised Ri
