Related Experiment Video
Updated: Aug 27, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Guideline adherence in febrile children below 3 months visiting European Emergency Departments: an observational
Chantal D Tan1, Eline E P L van der Walle1, Clementien L Vermont2
1Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands.
Insights
Management of febrile infants under 3 months varies widely across European emergency departments. Guideline adherence is limited, highlighting a need for optimized diagnostic and treatment strategies for serious bacterial infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Healthcare Management
Background:
- Febrile infants under 3 months face a high risk of serious bacterial infections (SBIs).
- Current management practices for these infants exhibit significant variation across European emergency departments (EDs).
- Discrepancies in guideline implementation and adherence contribute to inconsistent care.
Purpose of the Study:
- To evaluate the adherence to fever management guidelines in febrile infants under 3 months presenting to European EDs.
- To assess practice variations in diagnostics, antibiotic treatment, and admission rates for this vulnerable population.
Main Methods:
- Observational, multicenter study (MOFICHE) using routine data from 12 EDs in 8 European countries.
- Analysis of management strategies (diagnostic tests, antibiotic treatment, admission) in febrile infants (<3 months, excluding bronchiolitis) compared to established guidelines.
- Inclusion of 913 infants with a median age of 1.7 months.
Main Results:
- Significant variation in management practices observed across EDs: diagnostic tests (14-83%), antibiotic treatment (23-54%), and admission (34-86%).
- Guideline adherence rates were moderate: blood cultures (43%), lumbar punctures (29%), antibiotic prescriptions (55%), and admission (67%).
- Full guideline adherence for key components was achieved in only 15% of cases, with partial adherence in 56%.
Conclusions:
- Substantial practice variation exists in the management of febrile infants under 3 months in European EDs.
- Limited guideline adherence suggests a need for improved implementation and potential guideline revision.
- Highest adherence for admission indicates a generally cautious approach; future research should explore new biomarkers to optimize care.
Abstract:
Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. There is practice variation in management due to differences in guidelines and their usage and adherence. We aimed to assess whether management in febrile children below 3 months attending European Emergency Departments (EDs) was according to the guidelines for fever. This study is part of the MOFICHE study, which is an observational multicenter study including routine data of febrile children (0-18 years) attending twelve EDs in eight European countries. In febrile children below 3 months (excluding bronchiolitis), we analyzed actual management compared to the guidelines for fever. Ten EDs applied the (adapted) NICE guideline, and two EDs applied local guidelines. Management included diagnostic tests, antibiotic treatment, and admission. We included 913 children with a median age of 1.7 months (IQR 1.0-2.3). Management per ED varied as follows: use of diagnostic tests 14-83%, antibiotic treatment 23-54%, admission 34-86%. Adherence to the guideline was 43% (374/868) for blood cultures, 29% (144/491) for lumbar punctures, 55% (270/492) for antibiotic prescriptions, and 67% (573/859) for admission. Full adherence to these four management components occurred in 15% (132/868, range 0-38%), partial adherence occurred in 56% (484/868, range 35-77%).
Conclusion:
There is large practice variation in management. The guideline adherence was limited, but highest for admission which implies a cautious approach. Future studies should focus on guideline revision including new biomarkers in order to optimize management in young febrile children.
What Is Known:
• Febrile children below 3 months have a higher risk of serious bacterial infections, which often leads to extensive diagnostics and treatment. • There is practice variation in management of young febrile children due to differences in guidelines and their usage and adherence.
What Is New:
• Full guideline adherence is limited, whereas partial guideline adherence is moderate in febrile children below 3 months across Europe. • Guideline revision including new biomarkers is needed to improve management in young febrile children.
More Related Videos
Related Concept Videos
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:25Increased Body Temperature
01:29Decreased Body Temperature
01:19Guidelines For Measuring Vital Signs
Before taking a patient's vital signs, a nurse would consider and assess the patient's comfort level and ensure appropriate equipment is available.
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...