Children with fever without apparent source: diagnosis and dilemmas

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.

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