24 results found
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, 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.
Suzuki H, Dewez JE, Nijman R, et al., 2020, Clinical practice guidelines for acute otitis media in children: A systematic review and appraisal of European national guidelines, BMJ Open, Vol: 10, Pages: 1-10, ISSN: 2044-6055
Objectives: To appraise European guidelines for acute otitis media (AOM) in children, including methodological quality, level of evidence and strength of recommendations (SoR), and consideration of antibiotic stewardship.Design: Systematic review of the literatureData sources: Three-pronged search of 1) Databases: Medline, Embase, Cochrane library, Guidelines International Network, and Trip Medical Database; 2) websites of European national paediatric associations and 3) contact of European experts. Data was collected between January 2017-February 2018.Eligibility criteria:National guidelines of European countries for the clinical management of AOM in children aged <16 years. Data extraction and synthesis:Data was extracted using tables constructed by the research team. Guidelines were graded using AGREE II criteria. Level of Evidence (LoE) and Strength of Recommendations (SoR) were compared. Guidelines were assessed for principles of antibiotic stewardship. Results:AOM guidelines were obtained from 17 of the 32 EU/EFTA countries. The mean AGREE II score was ≤41% across most domains. Diagnosis of AOM was based upon similar signs and symptoms. The most common indication for antibiotics was tympanic membrane perforation/otorrhoea (14/15,93%). The majority (15/17;88%) recommended a watchful waiting approach to antibiotics. Amoxicillin was the most common first-line antibiotic (14/17;82%). Recommended treatment duration varied from five to ten days. Seven countries advocated high dose (75-90mg/kg/day) and five low dose (30-60mg/kg/day) amoxicillin. Less than 60% of guidelines used a national or international scale system to rate level of evidence to support recommendations. Under half of the guidelines (7/17; 41%) referred to country-specific microbiological and antibiotic resistance data. Conclusions:Guidelines for managing AOM were similar across European countries. Guideline quality was mostly weak, and often did not refer to country-specific antibiotic resis
Wang X, Nijman R, Camuzeaux S, et al., 2019, Plasma lipid profiles discriminate bacterial from viral infection in febrile children., Sci Rep, Vol: 9
Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics.
Bressan S, Titomanlio L, Gomez B, et al., 2019, Research priorities for European paediatric emergency medicine, Archives of Disease in Childhood, Vol: 104, Pages: 869-873, ISSN: 0003-9888
Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects.Design and Setting We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic.Results Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions ‘fever’, ‘sepsis’ and ‘respiratory infections’, and the processes/interventions ‘biomarkers’, ‘risk stratification’ and ‘practice variation’ as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research.Conclusions While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.
Dewez JE, Nijman RG, Yeung S, 2019, Fluids in the management of sepsis in children: a review of guidelines in the aftermath of the FEAST trial, Archives of Disease in Childhood, Vol: 104, Pages: 1236-1236, ISSN: 0003-9888
Levin M, Cunnington AJ, Wilson C, et al., 2019, Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial, Lancet Respiratory Medicine, Vol: 7, Pages: 581-593, ISSN: 2213-2600
BACKGROUND: Fluid resuscitation is the recommended management of shock, but increased mortality in febrile African children in the FEAST trial. We hypothesised that fluid bolus-induced deaths in FEAST would be associated with detectable changes in cardiovascular, neurological, or respiratory function, oxygen carrying capacity, and blood biochemistry. METHODS: We developed composite scores for respiratory, cardiovascular, and neurological function using vital sign data from the FEAST trial, and used them to compare participants from FEAST with those from four other cohorts and to identify differences between the bolus (n=2097) and no bolus (n=1044) groups of FEAST. We calculated the odds of adverse outcome for each ten-unit increase in baseline score using logistic regression for each cohort. Within FEAST participants, we also compared haemoglobin and plasma biochemistry between bolus and non-bolus patients, assessed the effects of these factors along with the vital sign scores on the contribution of bolus to mortality using Cox proportional hazard models, and used Bayesian clustering to identify subgroups that differed in response to bolus. The FEAST trial is registered with ISRCTN, number ISRCTN69856593. FINDINGS: Increasing respiratory (odds ratio 1·09, 95% CI 1·07-1·11), neurological (1·26, 1·21-1·31), and cardiovascular scores (1·09, 1·05-1·14) were associated with death in FEAST (all p<0·0001), and with adverse outcomes for specific scores in the four other cohorts. In FEAST, fluid bolus increased respiratory and neurological scores and decreased cardiovascular score at 1 h after commencement of the infusion. Fluid bolus recipients had mean 0·33 g/dL (95% CI 0·20-0·46) reduction in haemoglobin concentration after 8 h (p<0·0001), and at 24 h had a decrease of 1·41 mEq/L (95% CI 0·76-2·06; p=0·0002) in mean base excess and increase o
Borensztajn D, Yeung S, Hagedoorn NN, et al., 2019, Diversity in the emergency care for febrile children in Europe: a questionnaire study, BMJ Paediatrics Open, Vol: 3, ISSN: 2399-9772
Objective: To provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children. Design and setting: An electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK. Outcome measures: The questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates). Results: Reported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries. Conclusion: Differences in local, regional and national aspects of care exist in th
Stol K, Nijman RG, van Herk W, et al., 2019, Biomarkers for Infection in Children: Current Clinical Practice and Future Perspectives., Pediatr Infect Dis J, Vol: 38, Pages: S7-S13
Biomarkers have become an integral part of the clinical decision-making process of clinicians dealing with febrile children. C-reactive protein, procalcitonin and white blood cell count are probably the most studied ones. Crucial to using biomarkers is the understanding of how a test result will alter post-test probabilities and then impact on clinical decision making. Improved analytical and computational platforms have enabled the next generation of advanced biomarker discovery studies. Promising combinations of candidate biomarkers for a diverse spectrum of febrile illnesses, such as viral and bacterial infections, have been identified using proteomics, RNA gene expression and metabolomics.
Carter MJ, Stilwell PA, Nijman RG, et al., 2018, Identification and treatment of paediatric sepsis: getting the balance right, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 103, Pages: 1185-+, ISSN: 0003-9888
de Vos-Kerkhof E, Gomez B, Milcent K, et al., 2018, Clinical prediction models for young febrile infants at the emergency department: an international validation study, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 103, Pages: 1033-1041, ISSN: 0003-9888
Nijman RG, Vergouwe Y, Moll HA, et al., 2018, Validation of the Feverkidstool and procalcitonin for detecting serious bacterial infections in febrile children, PEDIATRIC RESEARCH, Vol: 83, Pages: 466-476, ISSN: 0031-3998
de Vos-Kerkhof E, Krecinic T, Vergouwe Y, et al., 2017, Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 102, Pages: 17-21, ISSN: 0003-9888
van Veen M, Nijman RG, Zijlstra M, et al., 2016, Neutrophil CD64 expression is not a useful biomarker for detecting serious bacterial infections in febrile children at the emergency department, INFECTIOUS DISEASES, Vol: 48, Pages: 331-337, ISSN: 2374-4235
Nijman RG, Moll HA, Vergouwe Y, et al., 2015, C-Reactive Protein Bedside Testing in Febrile Children Lowers Length of Stay at the Emergency Department, PEDIATRIC EMERGENCY CARE, Vol: 31, Pages: 633-639, ISSN: 0749-5161
de Vos-Kerkhof E, Nijman RG, Vergouwe Y, et al., 2015, Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial, PLoS One, Vol: 10, Pages: 1-15, ISSN: 1932-6203
ObjectivesTo assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI) attending the emergency department (ED).MethodsRandomized 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. The clinical decision model was evaluated by 1) area-under-the-receiver-operating-characteristic-curve (AUC) to indicate discriminative ability and 2) feasibility, to measure nurses’ compliance to model recommendations. 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.ResultsThe 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 were 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).ConclusionsIn 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
De Vos-Kerkhof E, Nijman RG, Vergouwe Y, et al., 2015, Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: A randomized controlled trial, Nederlands Tijdschrift voor Geneeskunde, Vol: 159, ISSN: 0028-2162
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). Method: Randomized controlled trial with 439 febrile children, aged 1 month16 years, attending the pediatric ED of a Dutch university hospital during 20102012. 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 Creactive protein and provided high/lowrisks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for highrisk 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 0.750.90)) and other SBI (n=22; AUC 0.81 (95% CI 0.720.90)). Compliance to model recommendations was high (86%). No differences in correct SBI determination was observed. Application of the clinical decision model resulted in less fullbloodcounts (14% vs. 22%, pvalue< 0.05) and more urinedipstick testing (71% vs. 61%, pvalue< 0.05). Conclusion: 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 bloodcounts and more rightfully urinedipstick testing.
Nijman RG, Moll HA, Smit FJ, et al., 2014, C-reactive Protein, Procalcitonin and the Lab-Score for Detecting Serious Bacterial Infections in Febrile Children at the Emergency Department A Prospective Observational Study, PEDIATRIC INFECTIOUS DISEASE JOURNAL, Vol: 33, Pages: E273-E279, ISSN: 0891-3668
van Ierland Y, Elshout G, Moll HA, et al., 2014, Use of alarm features in referral of febrile children to the emergency department: an observational study, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 64, Pages: E1-E9, ISSN: 0960-1643
Nijman RG, Oteman N, Oostenbrink R, 2014, [Guideline for febrile children in the hospital setting; relevance for general practitioners and paediatricians]., Ned Tijdschr Geneeskd, Vol: 158
Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from the vast majority with self-limiting diseases at an early stage. Alarm symptoms can aid in assessing the probability of serious infections in febrile children. The combined absence of alarm symptoms is useful in ruling out serious infections. CRP and PCT values are important diagnostic markers in febrile children in hospital settings. Children without any alarm symptoms and low inflammatory markers can be treated conservatively, provided there are good instructions on reassessment. Children with amber alarm symptoms or mildly elevated inflammatory markers in whom a serious infection cannot be ruled out require clinical observation or ambulant follow-up; empirical parenteral antibiotic treatment should also be considered and easily accessible. Children with red alarm symptoms or highly elevated inflammatory markers deserve clinical observation. In children < 3 months, empirical parenteral antibiotic treatment is also indicated.
Nijman RG, Vergouwe Y, Thompson M, et al., 2013, Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 346, ISSN: 1756-1833
Spruijt B, Vergouwe Y, Nijman RG, et al., 2013, Vital signs should be maintained as continuous variables when predicting bacterial infections in febrile children, JOURNAL OF CLINICAL EPIDEMIOLOGY, Vol: 66, Pages: 453-457, ISSN: 0895-4356
Nijman RG, Thompson M, van Veen M, et al., 2012, Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: prospective observational study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 344, ISSN: 1756-1833
Nijman RG, Zwinkels RLJ, van Veen M, et al., 2011, Can urgency classification of the Manchester triage system predict serious bacterial infections in febrile children?, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 96, Pages: 715-U175, ISSN: 0003-9888
Nijman RG, Oostenbrink R, Dons EM, et al., 2010, Parental Fever Attitude and Management Influence of Parental Ethnicity and Child's Age, PEDIATRIC EMERGENCY CARE, Vol: 26, Pages: 339-342, ISSN: 0749-5161
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