title: Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study.
abstract: OBJECTIVE
  To explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Febrile children attending a large tertiary care ED during the winter of 2014-2015.
  
  
  METHODS
  Ward and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use.
  
  
  RESULTS
  A total of 1097 children attending the children's ED with fever were analysed. Risk factors for PAU admission were tachycardia (RR=1.1, 95% CI (1 to 1.1)), ill-appearance (RR=2.2, 95% CI (1.2 to 4.2)), abnormal chest findings (RR=2.1, 95% CI (1.2 to 4.3)), categorised as NICE amber (RR 1.7 95% CI (1.2 to 2.5)). There was a 30% discordance between NICE categorisation at triage and statistical internal validation. Predictors of ward admission were a systemic (RR=6.9, 95% CI (2.4 to 19.8)) or gastrointestinal illness (RR=3.8, 95% (1.4 to 10.4)) and categorised as NICE Red (RR=5.9, 95% CI (2.2 to 15.3)). Only 51 children had probable bacterial pneumonia (4.6%), 52 children had a proven urinary tract infection (4.2%), with just 2 (0.2%) positive blood cultures out of 485 (44%) children who received an antibiotic. 15% of all children reattended by 28 days and were more likely to have been categorised as Amber and had investigations on initial visit.
  
  
  CONCLUSIONS
  Risk factors for PAU and ward admissions are different in this setting with high reattendance rates and very low proportion of confirmed/probable serious bacterial infections. Future studies need to focus on reducing avoidable admissions and antibiotic treatment.
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK.
authors.forename: Amaya L
authors.identifier: http://orcid.org/0000-0001-6131-4159
authors.initials: AL
authors.lastname: Bustinduy
authors.affiliation: Institute of Infection and Immunity, St George's University of London, London, UK.
authors.forename: Irina
authors.initials: I
authors.lastname: Chis Ster
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK.|Children's Emergency Department, St George's NHS trust, London, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Shaw
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK.
authors.forename: Adam
authors.identifier: http://orcid.org/0000-0001-8974-6789
authors.initials: A
authors.lastname: Irwin
authors.affiliation: Children's Emergency Department, St George's NHS trust, London, UK.
authors.forename: Jaiganesh
authors.initials: J
authors.lastname: Thiagarajan
authors.affiliation: Children's Emergency Department, St George's NHS trust, London, UK.
authors.forename: Rhys
authors.initials: R
authors.lastname: Beynon
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK.|Immunisation Department, Public Health England, London, UK.
authors.forename: Shamez
authors.initials: S
authors.lastname: Ladhani
authors.affiliation: Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005334:Fever / Q000453:epidemiology / Q000382:microbiology*; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008131:London / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D014218:Triage
chemical_list: D000900:Anti-Bacterial Agents
keywords: Accident & Emergency; General Paediatrics; Health services research; Infectious Diseases; Outcomes research