title: Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care.
abstract: BACKGROUND
  Follow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.
  
  
  OBJECTIVE
  To systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.
  
  
  METHODS
  MEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.
  
  
  METHODS
  Studies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).
  
  
  METHODS
  Two reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.
  
  
  RESULTS
  We summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians' characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.
  
  
  CONCLUSIONS
  Within the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.
authors.affiliation: Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: de Vos-Kerkhof
authors.affiliation: Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Dorien H F
authors.initials: DH
authors.lastname: Geurts
authors.affiliation: Erasmus University, Rotterdam, The Netherlands.
authors.forename: Mariska
authors.initials: M
authors.lastname: Wiggers
authors.affiliation: Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Moll
authors.affiliation: Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
mesh_terms: D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000592:standards; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data
keywords: Accident & Emergency; Epidemiology; Evidence Based Medicine; General Paediatrics; Infectious Diseases