title: Alarming signs and symptoms in febrile children in primary care: an observational cohort study in The Netherlands.
abstract: BACKGROUND
  Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections.
  
  
  OBJECTIVE
  To determine the frequency of alarming signs/symptoms in febrile children in primary care.
  
  
  METHODS
  Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded.
  
  
  METHODS
  General practitioners' out-of-hours service.
  
  
  METHODS
  Face-to-face patient contacts concerning children (aged ≤16 years) with fever were eligible for inclusion.
  
  
  METHODS
  Frequency of 18 alarming signs and symptoms as reported in the literature.
  
  
  RESULTS
  A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; <0.1%) to n = 2,207 (vomiting & diarrhea; 21.1%). Of all children, 59.7% had one or more alarming signs and/or symptoms. Several alarming signs/symptoms were poorly registered with the frequency of missing information ranging from 1,347 contacts (temperature >40°C as reported by the parents; 12.9%) to 8,647 contacts (parental concern; 82.5%).
  
  
  CONCLUSIONS
  Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness.
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Elshout
authors.affiliation: Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Yvette
authors.initials: Y
authors.lastname: van Ierland
authors.affiliation: Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Bohnen
authors.affiliation: Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: de Wilde
authors.affiliation: Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.affiliation: Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
authors.affiliation: Department of General Practice, University Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications; D008297:Male; D009426:Netherlands; D011320:Primary Health Care / Q000706:statistics & numerical data*