Affiliation:
1. University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction and Development Research Institute
2. Tergooi MC
3. Spaarne Ziekenhuis
4. Noordwest Ziekenhuisgroep
5. Flevoziekenhuis
6. Zaans Medical Center
7. Amsterdam University Medical Centers
8. Onze Lieve Vrouwe Gasthuis
Abstract
Abstract
Purpose
Evaluation of guidelines in actual practice is a crucial step in guideline improvement. Retrospective evaluation of the Dutch guideline for children with fever without an apparent source (FWS) showed 50% adherence in young infants. We prospectively evaluated adherence to the Dutch guideline and its impact on management in current practice.
Methods
Prospective observational multicenter study, including children three days to sixteen years old presented for FWS at one of seven Emergency Departments in participating secondary and tertiary care hospitals in the Netherlands. Adherence to the Dutch FWS guideline, adapted from the National Institute for Health and Care Excellence (NICE) guideline, was evaluated and patterns in non-adherence and the impact of non-adherence on clinical outcomes and resource use were explored.
Results
Adherence to the guideline was 192/370 (52%). Adherence was lowest in patients categorized as high risk for severe infection (72/187, 39%), compared to the low risk group (64/73, 88%). Differences in adherence were significant between risk categories (P < 0.001) but not between age categories. In case of non-adherence, less urinalysis, less bacterial cultures (blood, urine and cerebral spinal fluid) and less empirical antibiotic treatment were performed (P < 0.050). Clinical outcomes were not significantly different between the non-adherence and the adherence group, particularly regarding missed severe infections.
Conclusions
We found a high non-adherence rate of 48%, which did not lead to unfavorable clinical outcomes. This substantiates the need for a critical reevaluation of the FWS guideline and its indications for bacterial cultures, viral testing and antibiotic treatment.
Publisher
Research Square Platform LLC
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