[Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial].
OBJECTIVE
To assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI) attending the emergency department (ED).


METHODS
Randomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n=219) or the control group (usual care; n=220). The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.


RESULTS
The decision model had good discriminative ability for both pneumonia (n=33; AUC 0.83 (95% CI 0.75-0.90)) and other SBI (n=22; AUC 0.81 (95% CI 0.72-0.90)). Compliance to model recommendations was high (86%). No differences in correct SBI determination was observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value<0.05) and more urine-dipstick testing (71% vs. 61%, p-value<0.05).


CONCLUSIONS
In contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing. Trial registration: Trialregister.nl: NTR2381.
*Dit onderzoek werd eerder gepubliceerd in PLOS ONE (2015;10:e0127620) met als titel 'Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial'. Afgedrukt met toestemming.
Evelien
E
de Vos-Kerkhof
Ruud G
RG
Nijman
Yvonne
Y
Vergouwe
Suzanne
S
Polinder
Ewout W
EW
Steyerberg
Johan
J
van der Lei
Henriëtte  A
H
Moll
Rianne
R
Oostenbrink