Diversity in the emergency care for febrile children in Europe: a questionnaire study

Abstract

Objective: To provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children.

Design and setting: An electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK.

Outcome measures: The questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates).

Results: Reported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries.

Conclusion: Differences in local, regional and national aspects of care exist in the management of febrile children across Europe. This variability has to be considered when trying to interpret differences in the use of diagnostic tools, antibiotics and admission rates. Any future implementation of interventions or diagnostic tests will need to be aware of this European diversity.

Keywords: accident & emergency; infectious diseases.

Figure 1

Supervision type and frequency: office hours versus out-of-office hours. Direct supervision: the supervising physician is physically present on site with the resident and patient. Indirect supervision (I): with direct supervision immediately available—the supervising physician is physically present within the hospital and is immediately available to provide direct supervision. Indirect supervision (II): with direct supervision available—the supervising physician is not physically present within the hospital or other sites of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision in person within 20–30 min at all times. Oversight: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

Figure 2

Immunisation rates. Slovenia PCV rate (50%) not included in the graphic. PCV immunisation rate not available for Austria and Spain. DTaP: percentage of surviving infants who received the third dose of diphtheria and tetanus toxoid with pertussis-containing vaccine. MCV: percentage of surviving infants who received the first dose of measles-containing vaccine. In countries where the national schedule recommends the first dose of MCV at 12 months or later based on the epidemiology of disease in the country, coverage estimates reflect the percentage of children who received the first dose of MCV as recommended. Hib: percentage of surviving infants who received the third dose of Hib-containing vaccine. PCV: percentage of surviving infants who received the third dose of PCV. In countries where the national schedule recommends two doses during infancy and a booster dose at 12 months or later based on the epidemiology of disease in the country, coverage estimates may reflect the percentage of surviving infants who received two doses of PCV prior to the first birthday. DTaP, diphtheria, tetanus and acellular pertussis vaccine; Hib, Haemophilus influenzae type b vaccine; PCV, pneumococcal conjugate vaccine. MCV, measles-containing vaccine.