Self-referral and serious illness in children with fever
The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers...
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| Veröffentlicht in: | Pediatrics (Evanston) 2012-03, Vol.129 (3), p.e643-e651 |
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| container_title | Pediatrics (Evanston) |
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| creator | van Ierland, Yvette Seiger, Nienke van Veen, Mirjam van Meurs, Alfred H J Ruige, Madelon Oostenbrink, Rianne Moll, Henriëtte A |
| description | The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.
This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged |
| doi_str_mv | 10.1542/peds.2011-1952 |
| format | Article |
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This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged <16 years) who presented to the emergency department (2006-2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).
Thirty-eight percent of 4609 children were referred by their GP and 62% were self-referred. GP-referred children were classified as high urgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.
Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage self-referral to the emergency department should be reconsidered.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2011-1952</identifier><identifier>PMID: 22371470</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adolescent ; Child ; Child, Preschool ; Children ; Childrens health ; Confidence Intervals ; Cross-Sectional Studies ; Decision Making ; Diagnosis ; Diagnostic Self Evaluation ; Emergency Service, Hospital - utilization ; Family physicians ; Female ; Fever ; Fever - diagnosis ; Fever - therapy ; General Practice - methods ; General Practice - statistics & numerical data ; General practitioners ; Health aspects ; Hospitals, University ; Humans ; Hyperthermia ; Infant ; Intervention ; Male ; Netherlands ; Odds Ratio ; Parent-Child Relations ; Parents & parenting ; Pediatrics ; Physicians (General practice) ; Practice ; Referral and Consultation - statistics & numerical data ; Regression analysis ; Sensitivity and Specificity ; Severity of Illness Index</subject><ispartof>Pediatrics (Evanston), 2012-03, Vol.129 (3), p.e643-e651</ispartof><rights>Copyright American Academy of Pediatrics Mar 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-42748ef7f881a8e1722c8050427b29a39ccfbf7bb70a56e07fa8aac645189ff43</citedby><cites>FETCH-LOGICAL-c399t-42748ef7f881a8e1722c8050427b29a39ccfbf7bb70a56e07fa8aac645189ff43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22371470$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Ierland, Yvette</creatorcontrib><creatorcontrib>Seiger, Nienke</creatorcontrib><creatorcontrib>van Veen, Mirjam</creatorcontrib><creatorcontrib>van Meurs, Alfred H J</creatorcontrib><creatorcontrib>Ruige, Madelon</creatorcontrib><creatorcontrib>Oostenbrink, Rianne</creatorcontrib><creatorcontrib>Moll, Henriëtte A</creatorcontrib><title>Self-referral and serious illness in children with fever</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.
This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged <16 years) who presented to the emergency department (2006-2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).
Thirty-eight percent of 4609 children were referred by their GP and 62% were self-referred. GP-referred children were classified as high urgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.
Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage self-referral to the emergency department should be reconsidered.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Childrens health</subject><subject>Confidence Intervals</subject><subject>Cross-Sectional Studies</subject><subject>Decision Making</subject><subject>Diagnosis</subject><subject>Diagnostic Self Evaluation</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Family physicians</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - diagnosis</subject><subject>Fever - therapy</subject><subject>General Practice - methods</subject><subject>General Practice - statistics & numerical data</subject><subject>General practitioners</subject><subject>Health aspects</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Hyperthermia</subject><subject>Infant</subject><subject>Intervention</subject><subject>Male</subject><subject>Netherlands</subject><subject>Odds Ratio</subject><subject>Parent-Child Relations</subject><subject>Parents & parenting</subject><subject>Pediatrics</subject><subject>Physicians (General practice)</subject><subject>Practice</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Regression analysis</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkT1PwzAQhi0EglJYGVHEwpRyduzYHlHFl4TUAZgtxz1DkJsUO-Xj3-OowMD0SqfnTo_uJeSEwowKzi7WuEwzBpSWVAu2QyYUtCo5k2KXTAAqWnIAcUAOU3oFAC4k2ycHjFWScgkToh4w-DKixxhtKGy3LBLGtt-kog2hw5SzK9xLG5YRu-KjHV4Kj-8Yj8ietyHh8U9OydP11eP8trxf3NzNL-9LV2k9jCZcoZdeKWoVUsmYUyAgzxumbaWd842XTSPBihpBequsdTUXVGnveTUl59u769i_bTANZtUmhyHYDrOl0aymQirOMnn2j3ztN7HLchlSWYNXkKFyCz3bgKbtXN8N-Dm4PgR8RpPV5wtzyRTTuhY1zfxsy7vYp5T_ZNaxXdn4ZSiYsQEzNmDGBszYQF44_bHYNCtc_uG_L6--AQV2f1Q</recordid><startdate>201203</startdate><enddate>201203</enddate><creator>van Ierland, Yvette</creator><creator>Seiger, Nienke</creator><creator>van Veen, Mirjam</creator><creator>van Meurs, Alfred H J</creator><creator>Ruige, Madelon</creator><creator>Oostenbrink, Rianne</creator><creator>Moll, Henriëtte A</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201203</creationdate><title>Self-referral and serious illness in children with fever</title><author>van Ierland, Yvette ; Seiger, Nienke ; van Veen, Mirjam ; van Meurs, Alfred H J ; Ruige, Madelon ; Oostenbrink, Rianne ; Moll, Henriëtte A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-42748ef7f881a8e1722c8050427b29a39ccfbf7bb70a56e07fa8aac645189ff43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Childrens health</topic><topic>Confidence Intervals</topic><topic>Cross-Sectional Studies</topic><topic>Decision Making</topic><topic>Diagnosis</topic><topic>Diagnostic Self Evaluation</topic><topic>Emergency Service, Hospital - utilization</topic><topic>Family physicians</topic><topic>Female</topic><topic>Fever</topic><topic>Fever - diagnosis</topic><topic>Fever - therapy</topic><topic>General Practice - methods</topic><topic>General Practice - statistics & numerical data</topic><topic>General practitioners</topic><topic>Health aspects</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Hyperthermia</topic><topic>Infant</topic><topic>Intervention</topic><topic>Male</topic><topic>Netherlands</topic><topic>Odds Ratio</topic><topic>Parent-Child Relations</topic><topic>Parents & parenting</topic><topic>Pediatrics</topic><topic>Physicians (General practice)</topic><topic>Practice</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Regression analysis</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Ierland, Yvette</creatorcontrib><creatorcontrib>Seiger, Nienke</creatorcontrib><creatorcontrib>van Veen, Mirjam</creatorcontrib><creatorcontrib>van Meurs, Alfred H J</creatorcontrib><creatorcontrib>Ruige, Madelon</creatorcontrib><creatorcontrib>Oostenbrink, Rianne</creatorcontrib><creatorcontrib>Moll, Henriëtte A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Ierland, Yvette</au><au>Seiger, Nienke</au><au>van Veen, Mirjam</au><au>van Meurs, Alfred H J</au><au>Ruige, Madelon</au><au>Oostenbrink, Rianne</au><au>Moll, Henriëtte A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Self-referral and serious illness in children with fever</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2012-03</date><risdate>2012</risdate><volume>129</volume><issue>3</issue><spage>e643</spage><epage>e651</epage><pages>e643-e651</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.
This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged <16 years) who presented to the emergency department (2006-2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).
Thirty-eight percent of 4609 children were referred by their GP and 62% were self-referred. GP-referred children were classified as high urgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.
Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage self-referral to the emergency department should be reconsidered.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>22371470</pmid><doi>10.1542/peds.2011-1952</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Pediatrics (Evanston), 2012-03, Vol.129 (3), p.e643-e651 |
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| subjects | Adolescent Child Child, Preschool Children Childrens health Confidence Intervals Cross-Sectional Studies Decision Making Diagnosis Diagnostic Self Evaluation Emergency Service, Hospital - utilization Family physicians Female Fever Fever - diagnosis Fever - therapy General Practice - methods General Practice - statistics & numerical data General practitioners Health aspects Hospitals, University Humans Hyperthermia Infant Intervention Male Netherlands Odds Ratio Parent-Child Relations Parents & parenting Pediatrics Physicians (General practice) Practice Referral and Consultation - statistics & numerical data Regression analysis Sensitivity and Specificity Severity of Illness Index |
| title | Self-referral and serious illness in children with fever |
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