Alarming signs of serious infections in febrile children: Studies in primary care and hospital emergency care

Abstract

Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011. Primary out-ofhours care is annually visited by approximately 600,000 children younger than 14 years of age and hospital emergency departments (EDs) by nearly 400,000 children in this age group. Fever is one of the most common reasons for children to consult a physician. The incidence of fever as a reason for contacting primary care is approximately 430 per 1,000 patients/year under the age of 5 years. The overall incidence rate of the diagnosis of fever (without apparent source) in primary care is 19.2 per 1,000 patients/year, with the highest rate for children less than one year (100 per 1,000 patients/year) and the lowest rate for children aged 10 to 17 years (2.7 per 1,000 patients/year). At the ED, fever is also one of the main presenting problems and accounts for about 10% to 30% of all visits by children. Most acute febrile illnesses are caused by self-limiting viral infections, which do not require antibiotic treatment, diagnostic procedures, or hospitalization. However, a minority of febrile children develop a serious infection, such as meningitis, sepsis, pneumonia or urinary tract infection, for which timely diagnosis and targeted therapy are necessary to prevent harm. In primary care, the annual incidence of serious infections is about 1%, with a peak incidence rate among the youngest children (0 to 4 years: 21.1 per 1,000 patients/year). At the hospital ED about 15% to 20% of febrile children are diagnosed with a serious infection. Serious infections are an important cause of morbidity and mortality, especially in young children. Infections accounted for about 15% to 20% of all childhood deaths by natural cause in the Netherlands and the United Kingdom.