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  • 1
    Online Resource
    Online Resource
    Are children with prolonged fever at a higher risk for serious illness? A prospective observational study
    BMJ ; 2023
    In:  Archives of Disease in Childhood Vol. 108, No. 8 ( 2023-08), p. 632-639
    Details
    In: Archives of Disease in Childhood, BMJ, Vol. 108, No. 8 ( 2023-08), p. 632-639
    Abstract: To describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs). Design Prospective observational study. Setting 12 European EDs. Patients Consecutive febrile children 〈 18 years between January 2017 and April 2018. Interventions Children with fever ≥5 days and their risks for serious bacterial infection (SBI) were compared with children with fever 〈 5 days, including diagnostic accuracy of non-specific symptoms, warning signs and C-reactive protein (CRP; mg/L). Main outcome measures SBI and other non-infectious serious illness. Results 3778/35 705 (10.6%) of febrile children had fever ≥5 days. Incidence of SBI in children with fever ≥5 days was higher than in those with fever 〈 5 days (8.4% vs 5.7%). Triage urgency, life-saving interventions and intensive care admissions were similar for fever ≥5 days and 〈 5 days. Several warning signs had good rule in value for SBI with specificities 〉 0.90, but were observed infrequently (range: 0.4%–17%). Absence of warning signs was not sufficiently reliable to rule out SBI (sensitivity 0.92 (95% CI 0.87–0.95), negative likelihood ratio (LR) 0.34 (0.22–0.54)). CRP 〈 20 mg/L was useful for ruling out SBI (negative LR 0.16 (0.11–0.24)). There were 66 cases (1.7%) of non-infectious serious illnesses, including 21 cases of Kawasaki disease (0.6%), 28 inflammatory conditions (0.7%) and 4 malignancies. Conclusion Children with prolonged fever have a higher risk of SBI, warranting a careful clinical assessment and diagnostic workup. Warning signs of SBI occurred infrequently but, if present, increased the likelihood of SBI. Although rare, clinicians should consider important non-infectious causes of prolonged fever.
    Type of Medium: Online Resource
    ISSN: 0003-9888 , 1468-2044
    URL: Article
    DOI: 10.1136/archdischild-2023-325343
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 1481191-1
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  • 2
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    Parents’ experiences with a sick or injured child during the COVID-19 lockdown: an online survey in the Netherlands
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 12 ( 2021-12), p. e055811-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 12 ( 2021-12), p. e055811-
    Abstract: To assess the impact of the COVID-19 lockdown on parents’ health-seeking behaviour and care for a sick or injured child in the Netherlands. Design and setting An online survey on parents’ experiences with a sick or injured child during the COVID-19 lockdown periods was disseminated through social media. Participants Parents living in the Netherlands with a sick or injured child during the lockdown periods from March to June 2020 and from December 2020 to February 2021 were eligible to participate. Outcome measures Descriptive statistics and thematic analysis were used to analyse family and children’s characteristics, parents’ response to a sick or injured child, and the perceived impact of the lockdown on child’s severity of illness and treatment reported by parents. Analyses were stratified for children with and without chronic conditions. Results Of the 105 parents who completed the survey, 83% reported they would have sought medical help before lockdown compared with 88% who did seek help during lockdown for the same specific medical problem. Parents reported that changes in health services affected their child’s severity of illness (31%) and their treatment (39%), especially for children with chronic conditions. These changes included less availability of healthcare services and long waiting lists, which mostly led to worsening of the child’s illness. During lockdown, there was no change in health-seeking behaviour by parents of children with a chronic condition (N=51) compared with parents of children without a chronic condition. Conclusion Parents in the Netherlands who completed the survey were not deterred from seeking medical help for their sick or injured child during the COVID-19 lockdown periods. However, changes in health services affected child’s severity of illness and treatment, especially for children with chronic conditions.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-055811
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 3
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    Online Resource
    Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 8 ( 2020-08), p. e035504-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 8 ( 2020-08), p. e035504-
    Abstract: Idiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may actually have an occult aetiology. It is unclear to what extent additional diagnostic modalities such as endoscopic ultrasonography (EUS) are warranted after a first episode of IAP in order to uncover this aetiology. Failure to timely determine treatable aetiologies delays appropriate treatment and might subsequently cause recurrence of acute pancreatitis. Therefore, the aim of the Pancreatitis of Idiopathic origin: Clinical added value of endoscopic UltraSonography (PICUS) Study is to determine the value of routine EUS in determining the aetiology of pancreatitis in patients with a first episode of IAP. Methods and analysis PICUS is designed as a multicentre prospective cohort study of 106 patients with a first episode of IAP after complete standard diagnostic work-up, in whom a diagnostic EUS will be performed. Standard diagnostic work-up will include a complete personal and family history, laboratory tests including serum alanine aminotransferase, calcium and triglyceride levels and imaging by transabdominal ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreaticography after clinical recovery from the acute pancreatitis episode. The primary outcome measure is detection of aetiology by EUS. Secondary outcome measures include pancreatitis recurrence rate, severity of recurrent pancreatitis, readmission, additional interventions, complications, length of hospital stay, quality of life, mortality and costs, during a follow-up period of 12 months. Ethics and dissemination PICUS is conducted according to the Declaration of Helsinki and Guideline for Good Clinical Practice. Five medical ethics review committees assessed PICUS (Medical Ethics Review Committee of Academic Medical Center, University Medical Center Utrecht, Radboud University Medical Center, Erasmus Medical Center and Maastricht University Medical Center). The results will be submitted for publication in an international peer-reviewed journal. Trial registration number Netherlands Trial Registry (NL7066). Prospectively registered.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-035504
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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