Analyzing and Forecasting Pediatric Fever Clinic Visits in High Frequency Using Ensemble Time-Series Methods After the COVID-19 Pandemic in Hangzhou, China: Retrospective Study.

BACKGROUND: The COVID-19 pandemic has significantly altered the global health and medical landscape. In response to the outbreak, Chinese hospitals have established 24-hour fever clinics to serve patients with COVID-19. The emergence of these clinics and the impact of successive epidemics have led to a surge in visits, placing pressure on hospital resource allocation and scheduling. Therefore, accurate prediction of outpatient visits is essential for informed decision-making in hospital management. OBJECTIVE: Hourly visits to fever clinics can be characterized as a long-sequence time series in high frequency, which also exhibits distinct patterns due to the particularity of pediatric treatment behavior in an epidemic context. This study aimed to build models to forecast fever clinic visit with outstanding prediction accuracy and robust generalization in forecast horizons. In addition, this study hopes to provide a research paradigm for time-series forecasting problems, which involves an exploratory analysis revealing data patterns before model development. METHODS: An exploratory analysis, including graphical analysis, autocorrelation analysis, and seasonal-trend decomposition, was conducted to reveal the seasonality and structural patterns of the retrospective fever clinic visit data. The data were found to exhibit multiseasonality and nonlinearity. On the basis of these results, an ensemble of time-series analysis methods, including individual models and their combinations, was validated on the data set. Root mean square error and mean absolute error were used as accuracy metrics, with the cross-validation of rolling forecasting origin conducted across different forecast horizons. RESULTS: Hybrid models generally outperformed individual models across most forecast horizons. A novel model combination, the hybrid neural network autoregressive (NNAR)-seasonal and trend decomposition using Loess forecasting (STLF), was identified as the optimal model for our forecasting task, with the best performance in all accuracy metrics (root mean square error=20.1, mean absolute error=14.3) for the 15-days-ahead forecasts and an overall advantage for forecast horizons that were 1 to 30 days ahead. CONCLUSIONS: Although forecast accuracy tends to decline with an increasing forecast horizon, the hybrid NNAR-STLF model is applicable for short-, medium-, and long-term forecasts owing to its ability to fit multiseasonality (captured by the STLF component) and nonlinearity (captured by the NNAR component). The model identified in this study is also applicable to hospitals in other regions with similar epidemic outpatient configurations or forecasting tasks whose data conform to long-sequence time series in high frequency exhibiting multiseasonal and nonlinear patterns. However, as external variables and disruptive events were not accounted for, the model performance declined slightly following changes in the COVID-19 containment policy in China. Future work may seek to improve accuracy by incorporating external variables that characterize moving events or other factors as well as by adding data from different organizations to enhance algorithm generalization.

Challenges in Evaluating Pediatric Fever and Rash in the Era of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C).

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged the medical community to characterize and treat a new illness. Now almost two years after the initial confirmed cases of COVID-19, medical teams are faced with another unique disease process temporally related to the pandemic-multisystem inflammatory syndrome in children (MIS-C). The comparison of these patients' presentations illustrates the new challenges of evaluating a pediatric rash and fever in the era of MIS-C. CASE REPORTS: This report presents three cases with features of MIS-C, positivity for SARS-CoV-2, rashes, fevers, gastrointestinal involvement, and elevated inflammatory markers. The first case poses a diagnostic dilemma. While the case 1 patient has many features of MIS-C, his nasal swab was positive for Methicillin-sensitive Staphylococcus Aureus (MSSA). While the second case falls into the case definition of MIS-C, the case 2 patient also met the criteria for atypical Kawasaki disease. Although the third case was positive for SARS-CoV-2, the patient comparatively had a mild elevation of inflammatory markers and a stable clinical course led the treatment team to be more suspicious of immunoglobulin A (IgA) vasculitis versus hand, foot, and mouth disease. The variability in skin rash in patients with MIS-C contributes to the challenge of correctly diagnosing and managing pediatric patients with fever and rash in the emergency department (ED). CONCLUSION: Although most children infected with SARS-CoV-2 are asymptomatic or present with mild respiratory illness, it is critical to recognize children at-risk for fluid-refractory shock in MIS-C. With the continuing SARS-CoV-2 pandemic, emergency department (ED) providers will have to be alert and have high suspicion when evaluating a child with a fever and a rash to properly identify children presenting with this serious illness.

Pediatric Fever.

Pediatric fever is a common complaint in children. The most common cause is self-limited viral infection. However, neonates and young infants are evaluated and treated differently than older, vaccinated, and clinically evaluable children. Neonates should be admitted to the hospital, young infants in the second month of life may be risk stratified, and those deemed low risk on testing may be sent home with close follow-up. Children older than 2 months may be evaluated clinically for signs of bacterial infection that require intervention. Urinary tract infections cause more than 90% of serious bacterial illness in children, and younger children have a higher incidence of infection.

Acetaminophen and ibuprofen in the treatment of pediatric fever: a narrative review.

OBJECTIVE: A narrative review of randomized, blinded, controlled studies assessing the antipyretic effect of ibuprofen versus acetaminophen or combined or alternating treatment in children was conducted. METHODS: Searches of the PubMed and Embase literature databases were conducted to identify relevant articles. Selected articles were limited to studies published in English that investigated OTC oral tablet and syrup formulations of acetaminophen and ibuprofen; there were no publication date limits. Open-label studies, nonrandomized studies, and those evaluating intravenous or suppository formulations of acetaminophen or ibuprofen were excluded. Variations in designs, endpoints, methods, and patient populations precluded our ability to conduct a formal systematic review. RESULTS: At physician-directed dosing (acetaminophen 15 mg/kg vs ibuprofen 10 mg/kg), no significant differences in antipyretic effects from 0‒6 h and between 0‒6, ‒12, ‒24, or ‒48 h, with single or multiple-doses, respectively, were observed. Tolerability profiles at physician dosing were similar. In 14 over-the-counter dose comparisons (acetaminophen, 10-15 mg/kg; ibuprofen, 2.5-10 mg/kg), antipyresis favored ibuprofen in 6, was similar between groups in 7, and favored acetaminophen (15 mg/kg vs ibuprofen 5 mg/kg) in 1 comparison. Both medications were well tolerated. Efficacy favored combination over individual components in 3 of 4 studies; alternating use results were mixed. All combination or alternating treatments were well tolerated. CONCLUSIONS: Antipyretic effects of ibuprofen and acetaminophen are similar at physician-directed doses; ibuprofen may be modestly superior at over-the-counter doses.

Consideration of the Management of Pediatric Fever Clinics During the Novel Coronavirus Pneumonia Outbreak.

Since the outbreak of 2019 novel coronavirus (2019-nCoV) infection in Wuhan City, China, pediatric cases have gradually increased. It is very important to prevent cross-infection in pediatric fever clinics, to identify children with fever in pediatric fever clinics, and to strengthen the management of pediatric fever clinics. According to prevention and control programs, we propose the guidance on the management of pediatric fever clinics during the nCoV pneumonia epidemic period, which outlines in detail how to optimize processes, prevent cross-infection, provide health protection, and prevent disinfection of medical staff. The present consideration statement summarizes current strategies on the pre-diagnosis, triage, diagnosis, treatment, and prevention of 2019-nCoV infection, which provides practical suggestions on strengthening the management of pediatric fever clinics during the nCoV pneumonia epidemic period.

Search Engine Queries for Pediatric Fever During "Cold and Flu" Season.

Introduction Pediatric fever is the most common chief complaint in patients under 15 years old. The objective of this paper is to characterize public search trends for pediatric fever in the United States using Google search engine queries. Methods and materials A cross-sectional survey of Google Trends searches for "toddler fever" was conducted from October 2018 to January 2019 during "cold and flu" season. Information collected included "Related Topics" and "Related Queries", which includes additional searches by individuals who searched for "toddler fever". Data are described in the results using Google's relative popularity. Results For this study, 91 weeks of data were queried. The median relative popularity over this time period was 65 (interquartile range, 58 - 74.5) out of 100. Individuals searching for this term also searched thematically for characterizations and descriptors of fever, types of symptoms associated with fever, and various treatments for fever. Conclusion The results of this study revealed an increased frequency of search engine queries for descriptors and qualifiers of symptoms associated with pediatric illness during the "cold and flu" season. Frequently queried terms suggest a need for increased health literacy regarding pediatric fever in the United States and may represent a need for further national educational resources.

Temporal artery and axillary thermometry comparison with rectal thermometry in children presenting to the ED.

BACKGROUND: Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal. METHODS: This prospective study included children age 0-36months presenting to the Emergency Department of a large military treatment facility. Rectal, axillary, and temporal artery temperatures were obtained. Test characteristics (sensitivity, specificity, NPV, PPV) were reported. The effect of cutoff values 99.9°F, 100.4°F, and 102.2°F on test characteristics were also evaluated. RESULTS: The sensitivities of axillary and temporal artery thermometry to detect rectal fever is 11.5% and 61.5% respectively. Cutoff values did not significantly alter test characteristics. In this study, temporal artery thermometry was 0.2°C lower than rectal temperature, axillary measurement was 0.9°C below the reference standard. Mean temperature difference in the febrile group between TAT and rectal thermometry was >0.5°C compared with a mean temperature difference 0.05°C in afebrile patients. CONCLUSION: The findings of our study do not support using axillary thermometry to screen pediatric patients for fever in the emergency department. TAT cannot be recommended as a rectal thermometry replacement where height and duration of fever are used in pediatric disease prediction models. TAT may have a role in screening for fever in the appropriate pediatric patient population like primary orthopedic or trauma presentations where the balance between device precision, data capture and patient comfort may favor use of TAT.