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2016 ; 175
(4
): 563-72
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Clinicians overestimation of febrile child risk assessment
#MMPMID26634248
deVos-Kerkhof E
; Roland D
; de Bekker-Grob E
; Oostenbrink R
; Lakhanpaul M
; Moll HA
Eur J Pediatr
2016[Apr]; 175
(4
): 563-72
PMID26634248
show ga
We aimed to estimate clinicians' based risk thresholds at which febrile children
would be managed as serious bacterial infections (SBI) to determine influencing
characteristics and to compare thresholds with prediction model (Feverkidstool)
risk estimates. Twenty-one video vignettes of febrile children visiting the
emergency department (ED) were assessed by 42 (40.4 %) international
paediatricians/paediatric emergency clinicians. Questions were related to
clinical risk scores of the child having SBI and SBI management decisions on
visual analogue scales. Feverkidstool risk scores were based on clinical
signs/symptoms and C-reactive protein. Amongst vignettes assigned to SBI
management, the median risk was 60 % (interquartile range (IQR) 30.0-80.5) and
16.0 % (IQR 5.0-32.0) when vignettes were not managed as SBI. Ill appearance and
aberrant circulatory signs were the most influencing factors, as age and duration
of fever were the least influencing factors on SBI management decisions.
Feverkidstool risk scores varied from 13 % (IQR 7.7-28.1) for SBI management to
7.3 % (IQR 5.7-16.3) for no SBI management. CONCLUSION: Clinicians assigned high
risk scores to children who they would have managed as SBI, mostly influenced by
ill appearance and aberrant circulation. In contrast to SBI risk assessment of
the Feverkidstool, clinicians' appeared to apply a more stepwise assessment of
the risk of presence/absence of SBI at different steps in the diagnostic and
therapeutic process. Uniform risk thresholds at which one should start SBI
management in febrile children remains unclear; risk thresholds at which we
refrained from SBI management were more consistent. WHAT IS KNOWN: ?Only a small
proportion of febrile children presenting to the emergency department will have
serious bacterial infections (SBI) and uniform risk thresholds to start or
withhold SBI treatment are not known. ?The low prevalence of SBI and consequently
the low exposure of clinicians to these infections make them rely more on
alarming signs or clinical decision rules. What is New: ?Previously identified
model predictors for SBI appeared to be significantly influencing factors in
clinicians' febrile child management in emergency care. ?Clinicians' wielded
higher risk thresholds regarding SBI febrile child management than reflected by
the clinical prediction model while smaller differences in risk thresholds
between clinical and model prediction were observed when clinicians refrained
from SBI management.
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