Related Experiment Videos
Self-referral and serious illness in children with fever
Yvette van Ierland1, Nienke Seiger, Mirjam van Veen
1Department of General Pediatrics, Erasmus MC/Sophia Children’s Hospital, Rotterdam, Netherlands. y.vanierland@erasmusmc.nl
Insights
Many parents accurately assess their child's illness severity when seeking emergency care. However, reconsidering interventions that discourage self-referral may prevent delayed diagnoses in febrile children.
Area of Science:
- Pediatrics
- Emergency Medicine
- Health Services Research
Background:
- Parental assessment of a febrile child's illness severity influences emergency department (ED) presentation.
- Understanding factors influencing parental decisions for ED visits is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To evaluate parents' ability to accurately assess their febrile child's illness severity.
- To compare illness severity markers between children referred by a general practitioner (GP) and those self-referred to the ED.
Main Methods:
- Cross-sectional observational study of children (<16 years) with fever presenting to university and teaching hospital EDs (2006-2008).
- Illness severity assessed using Manchester Triage System urgency, diagnostic/therapeutic interventions, and follow-up.
- Logistic regression analysis examined associations between referral type (GP vs. self-referral) and severity markers.
Main Results:
- 62% of 4609 children were self-referred; 38% were GP-referred.
- GP-referred children (46%) and self-referred children (45%) were classified as high urgency.
- GP referrals were more likely to require extensive interventions (43% vs. 27% for self-referrals).
Conclusions:
- While GP-referred children were generally more severely ill, many parents appropriately judged their child's condition, leading to ED visits.
- Interventions discouraging self-referral to the ED should be re-evaluated to prevent potential delays or missed diagnoses in febrile children.
Objective:
The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.
Methods:
This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged <16 years) who presented to the emergency department (2006-2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).
Results:
Thirty-eight percent of 4609 children were referred by their GP and 62% were self-referred. GP-referred children were classified as high urgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.
Conclusions:
Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage self-referral to the emergency department should be reconsidered.
Related Concept Videos
01:25Increased Body Temperature
01:26Patterns of Fever
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:25Types of Fever
Here are the different types of fever:
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.