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Tan, Chantal D, Vermont, Clementien L, Zachariasse, Joany M, von Both, Ulrich, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael et al (show 304 more authors) , Lim, Emma, Maconochie, Ian K, Martinon-Torres, Federico, Nijman, Ruud G, Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Zenz, Werner, Zavadska, Dace, Moll, Henriëtte A, Carrol, Enitan D, 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, Paz, Ivonne Pena, 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, González, Fernando Álvez, Farto, Cristina Balo, Barral-Arca, Ruth, Castro, María Barreiro, Bello, Xabier, García, Mirian Ben, Carnota, Sandra, Cebey-López, Miriam, CurrasTuala, María José, Suárez, Carlos Durán, Vicente, Luisa García, Gómez-Carballa, Alberto, Rial, Jose Gómez, Iglesias, Pilar Leboráns, Martinón-Torres, Federico, Martinón-Torres, Nazareth, Martinón Sánchez, José María, Pérez, Belén Mosquera, Pardo-Seco, Jacobo, Rodríguez, Lidia Piñeiro, Pischedda, Sara, Vázquez, Sara Rey, Calle, Irene Rivero, Rodríguez-Tenreiro, Carmen, Redondo-Collazo, Lorenzo, Ora, Miguel Sadiki, Fernández, Sonia Serén, Trasorras, Cristina Serén, Iglesias, Marisol Vilas, 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 MA, Secka, Fatou, Anderson, Suzanne, Sarr, Anna RocaIsatou, Saidykhan, Momodou, Darboe, Saffiatou, Ceesay, Samba, D’alessandro, Umberto, Moll, Henriëtte A, Borensztajn¹, 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, 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 
ORCID: 0000-0001-8357-7726, 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, Groot, Ronald de, Flier, Michiel van der, Jonge, Marien I de, Aerde, Koen van, Alkema, Wynand, Broek, Bryan van den, Gloerich, Jolein, Gool, Alain J van, Henriet, Stefanie, Huijnen, Martijn, Philipsen, Ria, Willems, Esther, Gerrits, GPJM, Leur, M van, Heidema, J, Haan, L de, Miedema, CJ, Neeleman, C, Obihara, CC, Tramper-Stranders, GA, 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, Devine, 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, Giessen, Ilona van der, Martin, Alex, Rashid, Aqeela, Rowlands, Emily, Vries, Gabriella de, Velden, Fabian van der, Valentine, Lucille, Martin, Mike, Mistry, Ravi, Both, Ulrich von, 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, Srovin, Tina Plankar, Bahovec, Natalija, Prunk, Petra, Osterman, Veronika, Avramoska, Tanja, Kuijpers, Taco, Jongerius, Ilse, Berg, JM van den, Schonenberg, D, Barendregt, AM, Pajkrt, D, Kuip, M van der, Furth, AM van, Sprenkeler, Evelien, Zandstra, Judith, Mierlo, G van and Geissler, J
(2023)
Emergency medical services utilisation among febrile children attending emergency departments across Europe: an observational multicentre study.
European Journal of Pediatrics, 182 (9).
pp. 3939-3947.
Access the full-text of this item by clicking on the
Open Access link.
Abstract
<jats:title>Abstract
</jats:title><jats:p>Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1–42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1–59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1–0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4–1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (<jats:italic>p</jats:italic> < 0.05).</jats:p><jats:p><jats:italic> Conclusion</jats:italic>: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented.
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<jats:td align="left"><jats:bold>What is Known:</jats:bold></jats:td>
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<jats:tr>
<jats:td align="left">•<jats:italic>Children constitute around 6–10% of all patients attending the emergency department by emergency medical services.</jats:italic></jats:td>
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<jats:td align="left">•<jats:italic>Discordant EMS use occurs in 37–61% of all children, with fever as most common presenting symptom for discordant EMS use in children.</jats:italic></jats:td>
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<jats:td align="left"><jats:bold>What is New:</jats:bold></jats:td>
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<jats:td align="left">•<jats:italic>There is large practice variation in EMS use among febrile children across Europe with discordance EMS use occurring in 29% (range 1–59%), which was associated with attendance during out of office hours and with settings with higher percentage of self-referrals to the ED.</jats:italic></jats:td>
</jats:tr>
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<jats:td align="left">•<jats:italic>Future research is needed focusing on non-medical factors (socioeconomic status, parental preferences and past experience, healthcare systems, referral pathways, out of hours services provision) that influence discordant EMS use in febrile children across Europe.</jats:italic></jats:td>
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</jats:tbody></jats:table></jats:table-wrap></jats:p>
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