Status: Funded - Open
Improving diagnostic research in children with fever at risk of serious bacterial infections at the emergency department
Ruud Nijman, M.D., M.Sc., Ph.D.
BACKGROUND: Fever is the single most common reason for children visiting pediatric emergency are facilities. Identifying children with serious bacterial infections amongst the large majority of febrile children with self-limiting illnesses remains a diagnostic dilemma.
GAP: Cross sectional measurements of vital parameters, such as heart rate and respiratory rate, and biomarkers, such as C-reactive protein and procalcitonin, have not sufficiently been capable of identifying those children with or without SBI.
HYPOTHESIS: Serial measurements of vital parameters, and their response to antipyretic treatment, and biomarkers can more reliably identify SBI in febrile children in emergency care facilities.
METHODS: A prospective observational study at two pediatric emergency departments in the Netherlands and the United Kingdom. Consecutive, previously healthy, children with fever aged 1 month to 16 years will be included. Standardized, electronic data will be collected routinely, as well as routine blood sampling, and follow up of included and consented patients.
RESULTS: Previously, newly derived continuous threshold values for vital parameters reflected normal values in febrile children more accurately. C-reactive protein and procalcitonin proved useful diagnostic tools in detecting SBI in febrile children, in particular combined with clinical signs and symptoms.
IMPACT: Improving diagnostic tools for febrile children potentially results in improved early recognition of SBI and thus reducing mortality and morbidity associated with SBI. It also aims to optimize antibiotics prescribing. Moreover, diagnostic tools can result in a reallocation of tasks, targeting overcrowding at EDs. This research project expects to influence everyday practice with hands-on clinical diagnostic tools that can be readily implemented within the foreseeable future.
Imperial College London
United Kingdom, Netherlands