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Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study.

Bustinduy, AL; Chis Ster, I; Shaw, R; Irwin, A; Thiagarajan, J; Beynon, R; Ladhani, SN; Sharland, M; CABIN network, (2017) Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study. Archives of Disease in Childhood, 102 (1). pp. 22-28. ISSN 0003-9888 https://doi.org/10.1136/archdischild-2016-310494
SGUL Authors: Sharland, Michael Roy Chis Ster, Delizia Irina

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Abstract

OBJECTIVE: To explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED). DESIGN: Prospective observational study. SETTING AND PATIENTS: Febrile children attending a large tertiary care ED during the winter of 2014-2015. MAIN OUTCOME MEASURES: Ward and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use. RESULTS: A total of 1097 children attending the children's ED with fever were analysed. Risk factors for PAU admission were tachycardia (RR=1.1, 95% CI (1 to 1.1)), ill-appearance (RR=2.2, 95% CI (1.2 to 4.2)), abnormal chest findings (RR=2.1, 95% CI (1.2 to 4.3)), categorised as NICE amber (RR 1.7 95% CI (1.2 to 2.5)). There was a 30% discordance between NICE categorisation at triage and statistical internal validation. Predictors of ward admission were a systemic (RR=6.9, 95% CI (2.4 to 19.8)) or gastrointestinal illness (RR=3.8, 95% (1.4 to 10.4)) and categorised as NICE Red (RR=5.9, 95% CI (2.2 to 15.3)). Only 51 children had probable bacterial pneumonia (4.6%), 52 children had a proven urinary tract infection (4.2%), with just 2 (0.2%) positive blood cultures out of 485 (44%) children who received an antibiotic. 15% of all children reattended by 28 days and were more likely to have been categorised as Amber and had investigations on initial visit. CONCLUSIONS: Risk factors for PAU and ward admissions are different in this setting with high reattendance rates and very low proportion of confirmed/probable serious bacterial infections. Future studies need to focus on reducing avoidable admissions and antibiotic treatment.

Item Type: Article
Additional Information: This article has been accepted for publication in Archives of Disease in Childhood following peer review. The definitive copyedited, typeset version Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study Amaya L Bustinduy, Irina Chis Ster, Rebecca Shaw, Adam Irwin, Jaiganesh Thiagarajan, Rhys Beynon, Shamez Ladhani, Mike Sharland , for the CABIN network Arch Dis Child 2017;102:22-28 archdischild-2016-310494 Published Online First: 22 August 2016 doi:10.1136/archdischild-2016-310494 is available online at: http://dx.doi.org/10.1136/archdischild-2016-310494
Keywords: Accident & Emergency, General Paediatrics, Health services research, Infectious Diseases, Outcomes research, CABIN network, Accident & Emergency, General Paediatrics, Health services research, Infectious Diseases, Outcomes research, Pediatrics, 1103 Clinical Sciences, 1114 Paediatrics And Reproductive Medicine, 1117 Public Health And Health Services
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Archives of Disease in Childhood
ISSN: 0003-9888
Language: ENG
Dates:
DateEvent
22 August 2016Published Online
2 August 2016Accepted
1 January 2017Published
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
13-14-060Wandsworth Clinical Commissioning GroupUNSPECIFIED
PubMed ID: 27551062
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/108193
Publisher's version: https://doi.org/10.1136/archdischild-2016-310494

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