Publications
261 results found
Hagedoorn N, Wagenaar J, Nieboer D, et al., 2021, Impact of a Clinical Decision Rule on Antibiotic Prescription for Children with suspected Lower Respiratory Tract Infections presenting to European Emergency Departments - A simulation study based on routine data, Journal of Antimicrobial Chemotherapy, ISSN: 0305-7453
Borensztajn D, Hagedoorn N, Rivero Calle I, et al., 2021, Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study, PLoS One, ISSN: 1932-6203
Goodacre S, Thomas B, Lee E, et al., 2020, Post-exertion oxygen saturation as a prognostic factor for adverse outcome in patients attending the emergency department with suspected COVID-19: a substudy of the PRIEST observational cohort study., Emerg Med J
BACKGROUND: Measurement of post-exertion oxygen saturation has been proposed to assess illness severity in suspected COVID-19 infection. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19. METHODS: We undertook a substudy of an observational cohort study across 70 emergency departments during the first wave of the COVID-19 pandemic in the UK. We collected data prospectively, using a standardised assessment form, and retrospectively, using hospital records, from patients with suspected COVID-19, and reviewed hospital records at 30 days for adverse outcome (death or receiving organ support). Patients with post-exertion oxygen saturation recorded were selected for this analysis. We constructed receiver-operating characteristic curves, calculated diagnostic parameters, and developed a multivariable model for predicting adverse outcome. RESULTS: We analysed data from 817 patients with post-exertion oxygen saturation recorded after excluding 54 in whom measurement appeared unfeasible. The c-statistic for post-exertion change in oxygen saturation was 0.589 (95% CI 0.465 to 0.713), and the positive and negative likelihood ratios of a 3% or more desaturation were, respectively, 1.78 (1.25 to 2.53) and 0.67 (0.46 to 0.98). Multivariable analysis showed that post-exertion oxygen saturation was not a significant predictor of adverse outcome when baseline clinical assessment was taken into account (p=0.368). Secondary analysis excluding patients in whom post-exertion measurement appeared inappropriate resulted in a c-statistic of 0.699 (0.581 to 0.817), likelihood ratios of 1.98 (1.26 to 3.10) and 0.61 (0.35 to 1.07), and some evidence of additional prognostic value on multivariable analysis (p=0.019). CONCLUSIONS: Post-exertion oxygen saturation provides modest prognostic information in the assessment of selected patients attending the emergency department with suspected COVID-19. TRIAL REGISTRATION NUMBE
Bressan S, Buonsenso D, Farrugia R, et al., 2020, Preparedness and response to Pediatric CoVID-19 in European Emergency Departments: a survey of the REPEM and PERUKI networks, Annals of Emergency Medicine, Vol: 76, Pages: 788-800, ISSN: 0196-0644
Study objectiveWe aimed to describe the variability and identify gaps in preparedness and response to the COVID-19 pandemic in European EDs caring for children.MethodsA cross-sectional point prevalence survey, was developed and disseminated through the pediatric emergency medicine research networks for Europe (REPEM) and the United Kingdom and Ireland (PERUKI). We aimed to include ten EDs for countries with > 20 million inhabitants and five EDs for less populated countries, unless the number of eligible EDs was below five. ED directors or their delegates completed the survey between March 20th and 21st to report practice at that time. We used descriptive statistics to analyse data.ResultsOverall 102 centers from 18 countries (86% response rate) completed the survey: 34% did not have an ED contingency plan for pandemics and 36% had never had simulations for such events. Wide variation on PPE items was shown for recommended PPE use at pre-triage and for patient assessment, with 62% of centers experiencing shortage in one or more PPE items, most frequently FFP2/N95 masks. Only 17% of EDs had negative pressure isolation rooms. COVID-19 positive ED staff was reported in 25% of centers.ConclusionWe found variation and identified gaps in preparedness and response to the COVID-19 epidemic across European referral EDs for children. A lack in early availability of a documented contingency plan, provision of simulation training, appropriate use of PPE, and appropriate isolation facilities emerged as gaps that should be optimized to improve preparedness and inform responses to future pandemics.
Goodacre S, Thomas B, Lee E, et al., 2020, Characterisation of 22445 patients attending UK emergency departments with suspected COVID-19 infection: Observational cohort study, PLOS ONE, Vol: 15, ISSN: 1932-6203
Hagedoorn N, Borensztajn D, Nijman R, et al., 2020, Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE a prospective observational study, Archives of Disease in Childhood, ISSN: 0003-9888
Objectives To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers.Design Prospective observational study.Setting 12 emergency departments (EDs) in 8 European countries.Patients Febrile children aged 0–18 years.Main outcome measures IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs).Results Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%–2.0% performed poorly (ranges: sensitivity 0.59–0.93, negative LR 0.14–0.57, specificity 0.52–0.88, positive LR 1.9–4.8) and comprised 9784 patients (60%).Conclusions The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions.
Maconochie IK, Aickin R, Hazinski MF, et al., 2020, Pediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, RESUSCITATION, Vol: 156, Pages: A120-A155, ISSN: 0300-9572
Nolan JP, Maconochie I, Soar J, et al., 2020, Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, RESUSCITATION, Vol: 156, Pages: A1-A22, ISSN: 0300-9572
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Morley PT, Atkins DL, Finn JC, et al., 2020, Evidence Evaluation Process and Management of Potential Conflicts of Interest 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, RESUSCITATION, Vol: 156, Pages: A23-A34, ISSN: 0300-9572
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- Citations: 3
Morley PT, Atkins DL, Finn JC, et al., 2020, Evidence Evaluation Process and Management of Potential Conflicts of Interest 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 142, Pages: S28-S40, ISSN: 0009-7322
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- Citations: 13
Maconochie IK, Aickin R, Hazinski MF, et al., 2020, Pediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 142, Pages: S140-S184, ISSN: 0009-7322
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- Citations: 5
Nolan JP, Maconochie I, Soar J, et al., 2020, Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, CIRCULATION, Vol: 142, Pages: S2-S27, ISSN: 0009-7322
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- Citations: 4
Topjian AA, Scholefield BR, Pinto NP, et al., 2020, P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation, CIRCULATION, Vol: 142, Pages: E246-E261, ISSN: 0009-7322
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- Citations: 2
Baldi E, Savastano S, Contri E, et al., 2020, Mandatory cardiopulmonary resuscitation competencies for undergraduate healthcare students in Europe A European Resuscitation Council guidance note, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, Vol: 37, Pages: 839-841, ISSN: 0265-0215
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- Citations: 1
Schinkelshoek G, Borensztajn DM, Zachariasse JM, et al., 2020, Management of children visiting the emergency department during out-of-office hours: An observational study, BMJ Paediatrics Open, Vol: 4
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. Background The aim was to study the characteristics and management of children visiting the emergency department (ED) during out-of-office hours. Methods We analysed electronic health record data from 119 204 children visiting one of five EDs in four European countries. Patient characteristics and management (diagnostic tests, treatment, hospital admission and paediatric intensive care unit admission) were compared between children visiting during office hours and evening shifts, night shifts and weekend day shifts. Analyses were corrected for age, gender, Manchester Triage System urgency, abnormal vital signs, presenting problems and hospital. Results Patients presenting at night were younger (median (IQR) age: 3.7 (1.4-8.2) years vs 4.8 (1.8-9.9)), more often classified as high urgent (16.3% vs 9.9%) and more often had ≥2 abnormal vital signs (22.8% vs 18.1%) compared with office hours. After correcting for disease severity, laboratory and radiological tests were less likely to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78-0.86 and aOR: 0.64, 95% CI 0.60-0.67, respectively); treatment was more likely to be undertaken (aOR: 1.56, 95% CI 1.49-1.63) and patients were more likely to be admitted to the hospital (aOR: 1.32, 95% CI 1.24-1.41) at night. Patterns in management during out-of-office hours were comparable between the different hospitals, with variability remaining. Conclusions Children visiting during the night are relatively more seriously ill, highlighting the need to keep improving emergency care on a 24-hour-a-day basis. Further research is needed to explain the differences in management during the night and how these differences affect patient outcomes.
Nijman R, Maconochie I, Lyttle M, et al., 2020, Emergency care provided to refugee children in Europe: RefuNET - a cross-sectional survey study, Emergency Medicine Journal, ISSN: 1472-0205
Nijman R, Joergensen R, Levin M, et al., 2020, Management of children with fever at risk for paediatric sepsis: a prospective study in paediatric emergency care, Frontiers in Pediatrics, Vol: 8, Pages: 1-17, ISSN: 2296-2360
Objective: To study warning signs of serious infections in febrile children presenting to PED, ascertain their risk of having sepsis, and evaluate their management.Design: Prospective observational study.Setting: A single pediatric emergency department (PED).Participants: Febrile children, aged 1 month−16 years, with >= 1 warning signs of sepsis.Interventions and Main outcome measures: Clinical characteristics, including different thresholds for tachycardia and tachypnoea, and their association with (1) delivery of pediatric sepsis 6 (PS6) interventions, (2) final diagnosis of invasive bacterial infection (IBI), (3) the risk for pediatric intensive care unit (PICU) admission, and (4) death.Results: Forty-one percent of 5,156 febrile children had warning signs of sepsis. 1,606 (34%) children had tachypnoea and 1,907 (39%) children had tachycardia when using APLS threshold values. Using the NICE sepsis guidelines thresholds resulted in 1,512 (32%) children having tachypnoea (kappa 0.56) and 2,769 (57%) children having tachycardia (kappa 0.66). Of 1,628 PED visits spanning 1,551 disease episodes, six children (0.4%) had IBI, with one death (0.06%), corresponding with 256 children requiring escalation of care according to sepsis guideline recommendations for each child with IBI. There were five additional PICU admissions (0.4%). 121 (7%) had intravenous antibiotics in PED; 39 children (2%) had an intravenous fluid bolus, inotrope drugs were started in one child. 440 children (27%) were reviewed by a senior clinician. In 4/11 children with IBI or PICU admission or death, PS6 interventions were delivered within 60 min after arriving. 1,062 (65%) visits had no PS6 interventions. Diagnostic performance of vital signs or sepsis criteria for predicting serious illness yielded a large proportion of false positives. Lactataemia was not associated with giving iv fluid boluses (p = 0.19) or presence of serious bacterial infections (p = 0.128).Conclusion: Many febrile chi
Hagedoorn N, Borensztajn D, Nijman R, et al., 2020, Variation in antibiotic prescription rates in febrile children presenting to Emergency Departments across Europe (MOFICHE): a multicentre observational study, PLoS Medicine, Vol: 17, ISSN: 1549-1277
BackgroundThe prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe.Methods and findingsBetween January 2017 and April 2018, data were prospectively collected on febrile children aged 0–18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), diseas
Werner KG, Qaiser S, Kabbouche MA, et al., 2020, Intravenous Migraine Treatment in Children and Adolescents (vol 24, 45, 2020), CURRENT PAIN AND HEADACHE REPORTS, Vol: 24, ISSN: 1531-3433
Zachariasse JM, Nieboer D, Maconochie IK, et al., 2020, Development and validation of a Paediatric Early Warning Score for use in the emergency department: a multicentre study, LANCET CHILD & ADOLESCENT HEALTH, Vol: 4, Pages: 583-591, ISSN: 2352-4642
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- Citations: 1
Werner KG, Qaiser S, Kabbouche MA, et al., 2020, Intravenous Migraine Treatment in Children and Adolescents, CURRENT PAIN AND HEADACHE REPORTS, Vol: 24, ISSN: 1531-3433
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- Citations: 1
Kiguchi T, Okubo M, Nishiyama C, et al., 2020, Out -of -hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR), RESUSCITATION, Vol: 152, Pages: 39-49, ISSN: 0300-9572
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- Citations: 10
Van de Voorde P, Biarent D, Bingham B, et al., 2020, Paediatric Basic and Advanced Life Support: European Resuscitation Council COVID-19 Guidelines, Notfall und Rettungsmedizin, Vol: 23, Pages: 251-256, ISSN: 1434-6222
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- Citations: 2
Hingley S, Booth A, Hodgson J, et al., 2020, Concordance between the 2010 and 2015 Resuscitation Guidelines of International Liaison Committee of Resuscitation Councils (ILCOR) members and the ILCOR Consensus of Science and Treatment Recommendations (CoSTRs), RESUSCITATION, Vol: 151, Pages: 111-117, ISSN: 0300-9572
Granfeldt A, Avis SR, Lind PC, et al., 2020, Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review, RESUSCITATION, Vol: 149, Pages: 150-157, ISSN: 0300-9572
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- Citations: 9
de Caen A, Moylan A, Maconochie IK, 2020, Epinephrine for Pediatric Out-of-Hospital Cardiac Arrest Some Reassurance, but no Answers, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 75, Pages: 205-206, ISSN: 0735-1097
Zachariasse JM, Borensztajn DM, Nieboer D, et al., 2020, Sex-specific differences in children attending the emergency department: prospective observational study, BMJ OPEN, Vol: 10, ISSN: 2044-6055
Deluca P, Coulton S, Alam MF, et al., 2020, Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs, Programme Grants for Applied Research, Vol: 8, Pages: 1-144, ISSN: 2050-4322
<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Objectives</jats:title> <jats:p>To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Twelve EDs in England (London, North East, and Yorkshire and The Humber).</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title>
Wen SH, Ong GY-K, Maconochie IK, et al., 2019, Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections, EMERGENCY MEDICINE JOURNAL, Vol: 36, Pages: 729-735, ISSN: 1472-0205
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- Citations: 2
Soar J, Maconochie I, Wyckoff MH, et al., 2019, 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, RESUSCITATION, Vol: 145, Pages: 95-150, ISSN: 0300-9572
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- Citations: 28
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