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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children
The Lancet Regional Health - Europe, Volume 8, Article 100173, Year 2021
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Description
Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods: The MOFICHE study prospectively collected data on febrile children (0–18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculating the area under the receiver operating curve (AUC). Findings: Of 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84). The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likelihood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predictive value 0.95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90- 0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use. Interpretation: Patient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow. Funding: European Union, NIHR, NHS. © 2021 The Author(s)
Authors & Co-Authors
Hagedoorn, Nienke N.
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Carrol, Enitan D.
United Kingdom, Liverpool
University of Liverpool
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
United Kingdom, Liverpool
Liverpool Health Partners
von Both, Ulrich
Germany, Munich
Ludwig-maximilians-universität München
Dewez, Juan Emmanuel
United Kingdom, London
London School of Hygiene & Tropical Medicine
Emonts, Marieke
United Kingdom, Newcastle
The Newcastle Upon Tyne Hospitals Nhs Foundation Trust
United Kingdom, Newcastle
Newcastle University
United Kingdom, Newcastle
Translational and Clinical Research Institute
van der Flier, Michiel
Netherlands, Utrecht
University Medical Center Utrecht
Netherlands, Nijmegen
Radboud University Medical Center
de Groot, Ronald C.A.
Netherlands, Nijmegen
Radboud University Medical Center
Herberg, Jethro Adam
United Kingdom, London
Imperial College London
United Kingdom, London
Imperial College Healthcare Nhs Trust
Kohlmaier, Benno
Austria, Graz
Medizinische Universität Graz
Lim, Emma J.
United Kingdom, Newcastle
The Newcastle Upon Tyne Hospitals Nhs Foundation Trust
United Kingdom, Newcastle
Newcastle University
Maconochie, Ian
United Kingdom, London
Imperial College London
United Kingdom, London
Imperial College Healthcare Nhs Trust
Martinón-Torres, Federico
Spain, Santiago de Compostela
Hospital Clínico Universitario de Santiago
Nieboer, Daan
Netherlands, Rotterdam
Erasmus Mc
Nijman, Ruud Gerard
United Kingdom, London
Imperial College London
United Kingdom, London
Imperial College Healthcare Nhs Trust
Oostenbrink, Rianne
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Pokorn, Marko
Slovenia, Ljubljana
Univerzitetni Klinični Center Ljubljana
Calle, Irene Rivero
Spain, Santiago de Compostela
Hospital Clínico Universitario de Santiago
Tsolia, Maria N.
Unknown Affiliation
Vermont, Clementien L.
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Yeung, Shunmay M.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Zavadska, Dace
Latvia, Riga
Bērnu Klīniskā Universitātes Slimnīca
Zenz, Werner M.
Austria, Graz
Medizinische Universität Graz
Levin, Michael L.
United Kingdom, London
Imperial College London
Moll, Henriëtte A.
Netherlands, Rotterdam
Erasmus Mc Sophia Children’s Hospital
Statistics
Citations: 4
Authors: 24
Affiliations: 18
Identifiers
Doi:
10.1016/j.lanepe.2021.100173
ISSN:
26667762
Research Areas
Health System And Policy
Maternal And Child Health