http://repub.eur.nl/res/aut/16043/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/29813/ 2008-02-01T00:00:00Z Objective: To compare polytomous and dichotomous logistic regression analyses in diagnosing serious bacterial infections (SBIs) in children with fever without apparent source (FWS). Study Design and Setting: We analyzed data of 595 children aged 1-36 months, who attended the emergency department with fever without source. Outcome categories were SBI, subdivided in pneumonia and other-SBI (OSBI), and non-SBI. Potential predictors were selected based on previous studies and literature. Four models were developed: a polytomous model, estimating probabilities for three diagnostic categories simultaneously; two sequential dichotomous models, which differed in variable selection, discriminating SBI and non-SBI in step 1, and pneumonia and OSBI in step 2; and model 4, where each outcome category was opposed to the other two. The models were compared with respect to the area under the receiver-operating characteristic curve (AUC) for each of the three outcome categories and to the variable selection. Results: Small differences were found in the variables that were selected in the polytomous and dichotomous models. The AUCs of the three outcome categories were similar for each modeling strategy. Conclusion: A polytomous logistic regression analysis did not outperform sequential and single application of dichotomous logistic regression analyses in diagnosing SBIs in children with FWS. http://repub.eur.nl/res/pub/35961/ 2007-04-01T00:00:00Z Background: In light of the possibly preventive role of timing and amount of gluten in celiac disease, it would be helpful to have a questionnaire to assess the gluten intake in infants. Aims: Development and validation of a food questionnaire to assess gluten consumption in healthy infants aged 0-12 months (FQ-gluten). Methods: A food frequency questionnaire, previously developed for the Generation R study, was adapted for the assessment of gluten intake. The results of a 2-day food record (FR) were compared with the results of this FQ-gluten. Results: Eighty-seven parents filled in the FR and the FQ-gluten. The number of children who consume gluten and who are breast-fed is higher, reported in the FQ-gluten. The amount of gluten is comparable from the age of 3 up to 10 months, but at 11 and 12 months a higher gluten intake is reported using the FR, probably due to a larger variety of food products not detectable by the FQ-gluten. However, there is a high agreement in the food groups (Cohens' κ=0.6-0.8). Conclusions: This new, short, standardized, validated and easy to use FQ-gluten may be a useful instrument to assess gluten intake in infants, both at the individual and at the population level. The use of this method by investigators in other countries provides the opportunity for a better comparison of the results of gluten consumption in (co-operative) studies throughout different countries. http://repub.eur.nl/res/pub/36342/ 2007-01-01T00:00:00Z Aim: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source. Methods: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression. Results: the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis ≥70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88). Conclusions: A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further. http://repub.eur.nl/res/pub/14021/ 2006-07-13T00:00:00Z BACKGROUND: Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research. The aim of this project was to explore whether a previously developed generic (i.e. content independent) SDE application to support the structured documentation of narrative data (called OpenSDE) can be used to model data obtained at history taking and physical examination of a broad specialty. METHODS: OpenSDE was customized for the broad domain of general pediatrics: medical concepts and its descriptors from history taking and physical examination were modeled into a tree structure. RESULTS: An EMR system allowing structured recording (OpenSDE) of pediatric narrative data was developed. Patient history is described by 20 main concepts and physical examination by 11. In total, the thesaurus consists of about 1800 items, used in 8648 nodes in the tree with a maximum depth of 9 levels. Patient history contained 6312 nodes, and physical examination 2336. User-defined entry forms can be composed according to individual needs, without affecting the underlying data representation. The content of the tree can be adjusted easily and sharing records among different disciplines is possible. Data that are relevant in more than one context can be accessed from multiple branches of the tree without duplication or ambiguity of data entry via "shortcuts". CONCLUSION: An expandable EMR system with structured data entry (OpenSDE) for pediatrics was developed, allowing structured documentation of patient history and physical examination. For further evaluation in other environments, the tree structure for general pediatrics is available at the Erasmus MC Web site (in Dutch, translation into English in progress) 1. The generic OpenSDE application is available at the OpenSDE Web site 2. http://repub.eur.nl/res/pub/31961/ 2002-09-11T00:00:00Z Tills thesis describes the results of diagnostic research in young children presenting with fever without apparent source at the emergency department. The study was conducted at the Sophia Children's University Hospital in Rotterdam and the Juliana Children's Hospital in The Hague, both large inner-city paediatric teaching hospitals in the Netherlands. The specific aims of the studies are: 1. To describe trends in the management of children visiting the emergency department with fever without apparent source. 2. To develop a diagnostic prediction rule for referred patients presenting with fever without apparent source, including readily obtainable parameters from the patient's history, physical examination and laboratory tests in order to distinguish the patients with a serious bacterial infection from those without a serious bacterial infection. 3. To externally validate this developed diagnostic prediction rule for referred patients. 4. To obtain a diagnostic prediction rule for self-referred patients presenting with fever without apparent source, including the determination of the generalisability of the previously developed prediction rule for referred patients. 5. To deal with pitfalls with regard to diagnostic research on routine care data. 6. To compare results of internal and external validation of the developed diagnostic prediction rule for referred patients. 7. To develop a computer-based patient record for structured data entry for paediatric practice, in particular for recording data from the patient's history and physical exarnination.