Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational multicenter study
Authors: Tan Chantal D. , van der Walle Eline E. P. L. , Vermont Clementien L. , von Both Ulrich , Carrol Enitan D. , Eleftheriou Irini , Emonts Marieke , van der Flier Michiel , de Groot Ronald , Herberg Jethro , Kohlmaier Benno , Levin Michael , Lim Emma , Maconochie Ian K. , Martinon-Torres Federico , Nijman Ruud G. , Pokorn Marko , Rivero-Calle Irene , Tsolia Maria , Yeung Shunmay , Zenz Werner , Zavadska Dace , Moll Henriëtte A. ,   PERFORM consortium (Personalised Risk assessment in febrile children to optimize Real-life Management across the European Union), Levin Michael , Cunnington Aubrey , De Tisham , Herberg Jethro , Kaforou Myrsini , Wright Victoria , Baumard Lucas , Bellos Evangelos , D’Souza Giselle , Galassini Rachel , Habgood-Coote Dominic , Hamilton Shea , Hoggart Clive , Hourmat Sara , Jackson Heather , Maconochie Ian , Menikou Stephanie , Lin Naomi , Nichols Samuel , Nijman Ruud , Pena Paz Ivonne , Shah Priyen , Shen Ching-Fen , Vito Ortensia , Wilson Clare , Abdulla Amina , Ali Ladan , Darnell Sarah , Jorgensen Rikke , Mustafa Sobia , Persand Salina , Stevens Molly , Kim Eunjung , Pierce Benjamin , Fidler Katy , Dudley Julia , Richmond Vivien , Tavliavini Emma , Liu Ching-Chuan , Wang Shih-Min , Martinón-Torres Federico , Salas Antonio , Álvez González Fernando , Balo Farto Cristina , Barral-Arca Ruth , Barreiro Castro María , Bello Xabier , García Mirian Ben , Carnota Sandra , Cebey-López Miriam , Curras-Tuala María José , Durán Suárez Carlos , García Vicente Luisa , Gómez-Carballa Alberto , Gómez Rial Jose , Leboráns Iglesias Pilar , Martinón-Torres Federico , Martinón-Torres Nazareth , Martinón Sánchez José María , Mosquera Pérez Belén , Pardo-Seco Jacobo , Piñeiro Rodríguez Lidia , Pischedda Sara , Vázquez Sara Rey , Rivero Calle Irene , Rodríguez-Tenreiro Carmen , Redondo-Collazo Lorenzo , Sadiki Ora Miguel , Salas Antonio , Serén Fernández Sonia , Serén Trasorras Cristina , Vilas Iglesias Marisol , Zavadska Dace , Balode Anda , Bārzdiņa Arta , Deksne Dārta , Gardovska Dace , Grāvele Dagne , Grope Ilze , Meiere Anija , Nokalna Ieva , Pavāre Jana , Pučuka Zanda , Selecka Katrīna , Sidorova Aleksandra , Svile Dace , Urbāne Urzula Nora , Usuf Effua , Bojang Kalifa , Zaman Syed M. A. , Secka Fatou , Anderson Suzanne , Roca Anna , Sarr Isatou , Saidykhan Momodou , Darboe Saffiatou , Ceesay Samba , D’alessandro Umberto , Moll Henriëtte A. , Borensztajn Dorine M. , Hagedoorn Nienke N. , Tan Chantal , Vermont Clementien L. , Zachariasse Joany , Dik W. , Agyeman Philipp , Schlapbach Luregn J. , Aebi Christoph , Wyss Verena , Usman Mariama , Agyeman Philipp , Schlapbach Luregn J. , Giannoni Eric , Stocker Martin , Posfay-Barbe Klara M. , Heininger Ulrich , Bernhard-Stirnemann Sara , Niederer-Loher Anita , Kahlert Christian , Natalucci Giancarlo , Relly Christa , Riedel Thomas , Aebi Christoph , Berger Christoph , Carrol Enitan D. , Paulus Stéphane , Cocklin Elizabeth , Jennings Rebecca , Johnston Joanne , Leigh Simon , Newall Karen , Romaine Sam , Tsolia Maria , Eleftheriou Irini , Tambouratzi Maria , Marmarinos Antonis , Xagorari Marietta , Syggelou Kelly , Fink Colin , Voice Marie , Calvo-Bado Leo , Zenz Werner , Kohlmaier Benno , Schweintzger Nina A. , Sagmeister Manfred G. , Kohlfürst Daniela S. , Zurl Christoph , Binder Alexander , Hösele Susanne , Leitner Manuel , Pölz Lena , Rajic Glorija , Bauchinger Sebastian , Baumgart Hinrich , Benesch Martin , Ceolotto Astrid , Eber Ernst , Gallistl Siegfried , Gores Gunther , Haidl Harald , Hauer Almuthe , Hude Christa , Keldorfer Markus , Krenn Larissa , Pilch Heidemarie , Pfleger Andreas , Pfurtscheller Klaus , Nordberg Gudrun , Niedrist Tobias , Rödl Siegfried , Skrabl-Baumgartner Andrea , Sperl Matthias , Stampfer Laura , Strenger Volker , Till Holger , Trobisch Andreas , Löffler Sabine , Yeung Shunmay , Dewez Juan Emmanuel , Hibberd Martin , Bath David , Miners Alec , Nijman Ruud , Wedderburn Catherine , Meierford Anne , Leurent Baptiste , de Groot Ronald , van der Flier Michiel , de Jonge Marien I. , van Aerde Koen , Alkema Wynand , van den Broek Bryan , Gloerich Jolein , van Gool Alain J. , Henriet Stefanie , Huijnen Martijn , Philipsen Ria , Willems Esther , Gerrits G.P.J.M. , van Leur M. , Heidema J. , de Haan L. , Miedema C.J. , Neeleman C. , Obihara C.C. , Tramper-Stranders G.A. , Pollard Andrew J. , Kandasamy Rama , Paulus Stéphane , Carter Michael J. , O’Connor Daniel , Bibi Sagida , Kelly Dominic F. , Gurung Meeru , Thorson Stephen , Ansari Imran , Murdoch David R. , Shrestha Shrijana , Oliver Zoe , Emonts Marieke , Lim Emma , Valentine Lucille , Allen Karen , Bell Kathryn , Chan Adora , Crulley Stephen , Devin Kirsty , Fabian Daniel , King Sharon , McAlinden Paul , McDonald Sam , McDonnell Anne , Pickering Ailsa , Thomson Evelyn , Wood Amanda , Wallia Diane , Woodsford Phil , Baxter Frances , Bell Ashley , Rhodes Mathew , Agbeko Rachel , Mackerness Christine , Baas Bryan , Kloosterhuis Lieke , Oosthoek Wilma , Arif Tasnim , Bennet Joshua , Collings Kalvin , van der Giessen Ilona , Martin Alex , Rashid Aqeela , Rowlands Emily , de Vries Gabriella , van der Velden Fabian , Valentine Lucille , Martin Mike , Mistry Ravi , von Both Ulrich , Kolberg Laura , Zwerenz Manuela , Buschbeck Judith , Bidlingmaier Christoph , Binder Vera , Danhauser Katharina , Haas Nikolaus , Griese Matthias , Feuchtinger Tobias , Keil Julia , Kappler Matthias , Lurz Eberhard , Muench Georg , Reiter Karl , Schoen Carola , Mallet François , Brengel-Pesce Karen , Pachot Alexandre , Mommert Marine , Pokorn Marko , Kolnik Mojca , Vincek Katarina , Plankar Srovin Tina , Bahovec Natalija , Prunk Petra , Osterman Veronika , Avramoska Tanja , Kuijpers Taco , Jongerius Ilse , van den Berg J.M. , Schonenberg D. , Barendregt A.M. , Pajkrt D. , van der Kuip M. , van Furth A.M. , Sprenkeler Evelien , Zandstra Judith , van Mierlo G. , Geissler J. 
Published: September 2022

Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0–18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0–2.3). Management per ED varied as follows: use of diagnostic tests 14–83%, antibiotic treatment 23–54%, admission 34–86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0–38%), partial adherence occurred in 56% (484/868, range 35–77%).

Conclusion: There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.

What is Known:• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment.• There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence.

What is New:• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe.• Guideline revision including new biomarkers is needed to improve management in young febrile children.