Duration of fever and serious bacterial infections in children: a systematic review.

BACKGROUND: Parents of febrile children frequently contact primary care. Longer duration of fever has been related to increased risk for serious bacterial infections (SBI). However, the evidence for this association remains controversial. We assessed the predictive value of duration of fever for SBI. METHODS: Studies from MEDLINE, Embase and Cochrane databases (from January 1991 to December 2009) were retrieved. We included studies describing children aged 2 months to 6 years in countries with high Haemophilus influenzae type b vaccination coverage. Duration of fever had to be studied as a predictor for serious bacterial infections. RESULTS: Seven studies assessed the association between duration of fever and serious bacterial infections; three of these found a relationship. CONCLUSION: The predictive value of duration of fever for identifying serious bacterial infections in children remains inconclusive. None of these seven studies was performed in primary care. Studies evaluating the duration of fever and its predictive value in children in primary care are required.

Triage of febrile children at a GP cooperative: determinants of a consultation.

BACKGROUND: Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. AIM: To investigate the determinants related to the outcome of triage in febrile children. DESIGN OF STUDY: Cross-sectional study. SETTING: Dutch GP cooperative. METHOD: Receptionists filled out a triage questionnaire when parents called regarding their febrile child (aged between 3 months and 6 years) and estimated the level of concern of the parents. The outcome was either telephone advice, a consultation, or a home visit. Children were divided in subgroups based on age <18 months or > or = 18 months, and prognostic models for a consultation were constructed. RESULTS: Of 422 children, 73% were seen by a GP. Children aged <18 months were more likely to be seen when their parents reported less drinking or shortness of breath. In children aged > or = 18 months, a duration of fever of > or = 3 days, drowsiness, or a pale, ashen, or mottled skin were predictors of consultation. Children with alarm symptoms were seen according to the guideline. In both subgroups, children without alarm symptoms were more likely to be seen when their parents were concerned. CONCLUSION: The available guideline was followed to a large extent at a GP cooperative. Because, surprisingly, most children were reported to have alarm symptoms, the validity of the triage questions asking parents about alarm symptoms is questionable.

Respiratory virus infections in febrile children presenting to a general practice out-of-hours service.

BACKGROUND: Fever is common in young children and is assumed to be frequently caused by viral infections. OBJECTIVES: To document respiratory viruses in children with fever presenting at a general practice out-of-hours service (OHS), evaluate presenting symptoms in febrile children with a virus infection, and examine the association between antibiotic prescription and the presence of a viral infection. METHODS: Nasopharyngeal swabs were obtained to detect respiratory viruses in non-hospitalized children aged ≥ three months to six years presenting with fever at an OHS. Symptoms were assessed using physical examinations and questionnaires. Logistic regression analysis was used to reveal associations between symptoms or diagnoses, and the presence of at least one virus RESULTS: In total 257 nasopharyngeal swabs were obtained in 306 eligible children; 53% of these children were infected by at least one virus. The most frequently detected viruses were adenovirus (10.9%), RSV type A (10.5%) and PIV type 1 (8.6%). Cough (OR 2.6; 95% CI: 1.4-4.6) and temperature ≥ 38.0°C (OR 2.1; 95% CI: 1.3-3.5) were independent predictors of the presence of a virus, but the discriminative ability was low (AUC 0.64; 95% CI: 0.58-0.71). Antibiotic prescription rate was 37.3%. In 57.4% of children with an antibiotic prescription, a virus was found. CONCLUSION: In over 50% of all febrile children presenting at an OHS, a virus was found. Antibiotic prescription rate was high and not associated to the outcome of viral testing.

Point-of-care C-reactive protein testing in febrile children in general practice.

BACKGROUND: Point-of-care testing for C-reactive protein (CRP) may be helpful in differentiating viral from bacterial infection. Such a device should give results comparable to laboratory testing. The aim was to evaluate two point-of-care CRP tests (Nycocard and QuikRead) in febrile children in general practice, compared to a reference immunoturbidimetric assay. METHODS: A cross-sectional study was carried out of febrile children aged 3 months to 6 years presented to a general practice out-of-hours service. Children were visited at home where blood was taken for tests, within 24 h after presentation. The Nycocard test was performed at home, whereas the QuikRead and reference test were performed in the laboratory. RESULTS: A total of 76 children were enrolled. All three CRP tests were performed in 59 children. The mean difference between the reference test and Nycocard and QuikRead was 0.6 and -6.1 mg/L, respectively. The slope of the Passing-Bablok regression was 0.95 (95% CI 0.9-1.0) and 0.83 (95% CI 0.81-0.85) for the Nycocard and QuikRead tests, respectively. CONCLUSIONS: Up to a concentration of 160 mg/L, the Nycocard test correlated well with the reference test, while the QuikRead test underestimated concentrations above 60 mg/L. The Nycocard test seems a good candidate for CRP point-of-care testing in general practice.