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113 results on '"Borensztajn, Dorine"'

2. A multi-platform approach to identify a blood-based host protein signature for distinguishing between bacterial and viral infections in febrile children (PERFORM): a multi-cohort machine learning study

Author

Jackson, Heather Ruth, Zandstra, Judith, Menikou, Stephanie, Hamilton, Shea, McArdle, Andrew J, De, Tisham, Agyeman, Philipp K A, Von Both, Ulrich, Carrol, Enitan D, Emonts, Marieke, Eleftheriou, Irini, Van der Flier, Michiel, Fink, Colin, De Groot, Ronald, Moll, Henriette A, Pokorn, Marko, Pollard, Andrew, Schlapbach, Luregn J, Tsolia, Maria, Usuf, Effua, Wright, Victoria, Yeung, Shunmay, Zavadska, Dace, Zenz, Werner, Coin, Lachlan JM, Cunnington, Aubrey J, Martinon-Torres, Federico, Herberg, Jethro, De Jonge, Marien I, Levin, Michael, Kuijpers, Taco, Kaforou, Myrsini, Abdulla, Amina, Aebi, Christoph, Agbeko, Rachel, Ali, Ladan, Alkema, Wynand, Allen, Karen, Anderson, Suzanne, Ansari, Imran, Arif, Tasnim, Avramoska, Tanja, Baas, Bryan, Bahovec, Natalija, Balode, Anda, Bãrdzdina, Arta, Barendregt, A M, Barral-Arca, Ruth, Bath, David, Bauchinger, Sebastian, Baumard, Lucas, Baumgart, Hinrich, Baxter, Frances, Bell, Kathryn, Bell, Ashley, Bello, Xabier, Bellos, Evangelos, Benesch, Martin, Bennet, Joshua, Berger, Christoph, Bernhard-Stirnemann, Sara, Bibi, Sagida, Bidlingmaier, Christoph, Binder, Alexander, Binder, Vera, Blackmore, Jennifer, Bojang, Kalifa, Borensztajn, Dorine M, Brengel-Pesce, Karen, Broderick, Claire, Buschbeck, Judith, Calvo-Bado, Leonides, Carnota, Sandra, Carter, Michael J, Castro, María Barreiro, Cebey-López, Miriam, Ceesay, Samba, Ceolotto, Astrid, Chan, Adora, Cocklin, Elizabeth, Collings, Kalvin, Crulley, Stephen, Curras-Tuala, María José, D'alessandro, Umberto, D'Souza, Giselle, Danhauser, Katharina, Darboe, Saffiatou, Darnell, Sarah, De Haan, L, De Vries, Gabriella, Deksne, Dãrta, Devine, Kirsty, Dewez, Juan Emmanuel, Dik, W, Dudley, Julia, Eber, Ernst, Fabian, Daniel, Farto, Cristina Balo, Fernández, Sonia Serén, Fidler, Katy, Fitchett, Elizabeth, Galassini, Rachel, Gallisti, Siegfried, García, Mirian Ben, Gardovska, Dace, Geissler, J, Gerrits, G P J M, Giannoni, Eric, Gloerich, Jolein, Gómez-Carballa, Alberto, González, Fernando Álves, Gores, Gunther, Grãvele, Dagne, Griese, Matthias, Grope, Ilze, Gurung, Meeru, Haas, Nikolaus, Habgood-Coote, Dominic, Hagedoorn, Nienke N, Haidl, Harald, Harrison, Rebekah, Hauer, Almuthe, Heidema, J, Heininger, Ulrich, Henriet, Stefanie, Hibberd, Martin, Hoggart, Cllive, Hösele, Susanne, Hourmat, Sara, Hude, Christa, Huijnen, Martijn, Iglesias, Pilar Leboráns, Iglesias, Marisol Vilas, Jennings, Rebecca, Johnson, Joanne, Jongerius, Ilse, Jorgensen, Rikke, Kahlert, Christian, Kandasamy, Rama, Kappler, Matthias, Keldorfer, Markus, Kelly, Dominic F, Khanijau, Aakash, Kim, Nayoung, Kim, Eunjung, King, Sharon, Kolberg, Laura, Kolnik, Mojca, Kloosterhuis, Lieke, Kohlfürst, Daniela S, Kohlmaier, Benno, Krenn, Larissa, Leigh, Simon, Leitner, Manuel, Leurent, Baptiste, Lim, Emma, Lin, Naomi, Liu, Ching-Chuan, Löffler, Sabine, Lurz, Eberhard, Mackerness, Christine, Maconochie, Ian, Mallet, Francois, Marmarinos, Antonis, Martin, Alex, Martin, Mike, Martinón Sánchez, José María, Martinón-Torres, Nazareth, McAlinden, Paul, McDonald, Sam, McDonell, Anne, Meiere, Anija, Meierford, Anne, Miedema, C J, Miners, Alec, Mistry, Ravi, Mommert, Marine, Morris, Sophie, Muench, Georg, Murdoch, David R, Mustafa, Sobia, Natalucci, Giancarlo, Neeleman, C, Newall, Karen, Nichols, Samuel, Niederer-Loher, Anita, Niedrist, Tobias, Nijman, Ruud, Nokalna, Ieve, Nordberg, Gudrun, O'Connor, Daniel, Obihara, C C, Oliver, Zoe, Oosthoek, Wilma, Ora, Miguel Sadiki, Osterman, Veronika, Pachot, Alexandre, Pajkrt, D, Pardo-Seco, Jacobo, Pavãre, Jana, Paz, Ivonne Pena, Paulus, Stéphane, Pérez, Belén Mosquera, Persand, Salina, Pfleger, Andreas, Pfurtscheller, Klaus, Philipsen, Ria, Pickering, Alisa, Pierce, Benjamin, Pilch, Heidemarie, Pischedda, Sara, Pölz, Lena, Posfay-Barbe, Klara M, Powell, Oliver, Prunk, Petra, Pučuka, Zanda, Rajic, Glorija, Rashid, Aqeela, Redondo-Collazo, Lorenzo, Reiter, Karl, Relly, Christa, Rhodes, Mathew, Rial, Jose Gómez, Richmond, Vivien, Riedel, Thomas, Rivero Calle, Irene, Roca, Anna, Rödl, Siegfried, Rodríguez, Lidia Piñeiro, Rodríguez-Tenreiro, Carmen, Romaine, Sam, Rowlands, Emily, Rudzate, Aleksandra, Sagmeister, Manfred, Saidykhan, Momodou, Sallas, Antonio, Sarr, Isatou, Schoen, Carola, Schonenberg, D, Schweintzger, Nina, Secka, Fatou, Selecka, Katrīna, Shah, Priyen, Shen, Ching-Fen, Shrestha, Shrijana, Skrabl-Baumgartner, Andrea, Soon, Joshua, Sperl, Matthias, Sprenkeler, Evelien, Spyridis, Nikos, Srovin, Tina Plankar, Stampfer, Laura, Stevens, Molly, Stocker, Martin, Strenger, Volker, Suárez, Carlos Durán, Svile, Dace, Syggelou, Kelly, Tal, Chantal, Tambouratzi, Maria, Tavliavini, Emma, Thakker, Clare, Thomson, Evelyn, Throson, Stephen, Till, Holger, Tramper-Stranders, G A, Trasorras, Cristina Serén, Trobisch, Andreas, Urbãne, Urzula Nora, Usman, Mariama, Valentine, Lucille, Van Aerde, Koen, Van den Berg, J M, Van den Broek, Bryan, Van der Giessen, Ilona, Van der Kuip, M, Van der Velden, Fabian, Van Furth, A M, Van Gool, Alain J, Van Leur, M, van Mierlo, G, Vázquez, Sara Ray, Vermont, Clementien, Vicente, Luisa García, Vincek, Katarina, Vito, Ortensia, Voice, Marie, Wallia, Diane, Walsh, Ben, Wang, Shih-Min, Wedderburn, Catherine, Willems, Esther, Wilson, Clare, Wood, Amanda, Woodsford, Phil, Wyss, Verena, Xagorari, Marietta, Zachariasse, Joany, Zaman, Syed M A, Zurl, Christoph, Zwerenz, Manuela, Jackson, Heather R, Hamilton, Melissa Shea, Fischer, Roman, Thorne, Adam M, Huang, Honglei, Tanck, Michael W, Jansen, Machiel H, Pollard, Andrew J, Tsolia, Maria N, Wright, Victoria J, Coin, Lachlan J M, Casals-Pascual, Climent, Herberg, Jethro A, de Jonge, Marien I, and Kuijpers, Taco W

Published
2023
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3. Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study

Author

Shah, Priyen, Voice, Marie, Calvo-Bado, Leonides, Calle, Irene Rivero, Morris, Sophie, Nijman, Ruud, Broderick, Claire, De, Tisham, Eleftheriou, Irini, Galassini, Rachel, Khanijau, Aakash, Kolberg, Laura, Kolnik, Mojca, Rudzate, Aleksandra, Sagmeister, Manfred, Schweintzger, Nina, Secka, Fatou, Thakker, Clare, Van der Velden, Fabian, Vermont, Clementien, Vincek, Katarina, Agyeman, Philipp K.A., Cunnington, Aubrey J., De Groot, Ronald, Emonts, Marieke, Fidler, Katy, Kuijpers, Taco, Mommert-Tripon, Marine, Brengel-Pesce, Karen, Mallet, Francois, Moll, Henriette, Paulus, Stéphane, Pokorn, Marko, Pollard, Andrew, Schlapbach, Luregn J., Shen, Ching-Fen, Tsolia, Maria, Usuf, Effua, Van der Flier, Michiel, Von Both, Ulrich, Yeung, Shunmay, Zavadska, Dace, Zenz, Werner, Wright, Victoria, Carrol, Enitan D., Kaforou, Myrsini, Martinon-Torres, Federico, Fink, Colin, Levin, Michael, Herberg, Jethro, Baumard, Lucas, Bellos, Evangelos, Coin, Lachlan, D'Souza, Giselle, Habgood-Coote, Dominic, Hamilton, Shea, Hoggart, Cllive, Hourmat, Sara, Jackson, Heather, Lin, Naomi, Menikou, Stephanie, Nichols, Samuel, Paz, Ivonne Pena, Powell, Oliver, Vito, Ortensia, Wilson, Clare, Abdulla, Amina, Ali, Ladan, Darnell, Sarah, Jorgensen, Rikke, Maconochie, Ian, Mustafa, Sobia, Persand, Salina, Walsh, Ben, Stevens, Molly, Kim, Nayoung, Kim, Eunjung, Pierce, Benjamin, Dudley, Julia, Richmond, Vivien, Tavliavini, Emma, Liu, Ching-Chuan, Wang, Shih-Min, González, Fernando Álves, Farto, Cristina Balo, Barral-Arca, Ruth, Castro, María Barreiro, Bello, Xabier, Ben García, Mirian, Carnota, Sandra, Cebey-López, Miriam, Curras-Tuala, María José, Suárez, Carlos Durán, Vicente, Luisa García, Gómez-Carballa, Alberto, Rial, Jose Gómez, Iglesias, Pilar Leboráns, Martinón-Torres, Nazareth, Martinón Sánchez, José María, Pérez, Belén Mosquera, Pardo-Seco, Jacobo, Rodríguez, Lidia Piñeiro, Pischedda, Sara, Vázquez, Sara Ray, Rodríguez-Tenreiro, Carmen, Redondo-Collazo, Lorenzo, Ora, Miguel Sadiki, Sallas, Antonio, Fernández, Sonia Serén, Trasorras, Cristina Serén, Iglesias, Marisol Vilas, Balode, Anda, Bãrdzdina, Arta, Deksne, Dãrta, Gardovska, Dace, Grãvele, Dagne, Grope, Ilze, Meiere, Anija, Nokalna, Ieve, Pavãre, Jana, Pučuka, Zanda, Selecka, Katrīna, Svile, Dace, Urbãne, Urzula Nora, Bojang, Kalifa, Zaman, Syed M.A., Anderson, Suzanne, Roca, Anna, Sarr, Isatou, Saidykhan, Momodou, Darboe, Saffiatou, Ceesay, Samba, D'alessandro, Umberto, Borensztajn, Dorine M., Hagedoorn, Nienke N., Tal, Chantal, Zachariasse, Joany, Dik, W., Aebi, Christoph, Berger, Christoph, Wyss, Verena, Usman, Mariama, Giannoni, Eric, Stocker, Martin, Posfay-Barbe, Klara M., Heininger, Ulrich, Bernhard-Stirnemann, Sara, Niederer-Loher, Anita, Kahlert, Christian, Natalucci, Giancarlo, Relly, Christa, Riedel, Thomas, Cocklin, Elizabeth, Jennings, Rebecca, Johnson, Joanne, Leigh, Simon, Newall, Karen, Romaine, Sam, Tambouratzi, Maria, Marmarinos, Antonis, Xagorari, Marietta, Syggelou, Kelly, Spyridis, Nikos, Blackmore, Jennifer, Harrison, Rebekah, Kohlmaier, Benno, Kohlfürst, Daniela S., Zurl, Christoph, Binder, Alexander, Hösele, Susanne, Leitner, Manuel, Pölz, Lena, Rajic, Glorija, Bauchinger, Sebastian, Baumgart, Hinrich, Benesch, Martin, Ceolotto, Astrid, Eber, Ernst, Gallisti, Siegfried, Gores, Gunther, Haidl, Harald, Hauer, Almuthe, Hude, Christa, Keldorfer, Markus, Krenn, Larissa, Pilch, Heidemarie, Pfleger, Andreas, Pfurtscheller, Klaus, Nordberg, Gudrun, Niedrist, Tobias, Rödl, Siegfried, Skrabl-Baumgartner, Andrea, Sperl, Matthias, Stampfer, Laura, Strenger, Volker, Till, Holger, Trobisch, Andreas, Löffler, Sabine, Dewez, Juan Emmanuel, Hibberd, Martin, Bath, David, Miners, Alec, Fitchett, Elizabeth, Wedderburn, Catherine, Meierford, Anne, Leurent, Baptiste, De Jonge, Marien I., van Aerde, Koen, Alkema, Wynand, van den Broek, Bryan, Gloerich, Jolein, Van Gool, Alain J., Henriet, Stefanie, Huijnen, Martijn, Philipsen, Ria, Willems, Esther, Gerrits, G.P.J.M., Van Leur, M., Heidema, J., De Haan, L., Miedema, C.J., Neeleman, C., Obihara, C.C., Tramper-Stranders, G.A., Kandasamy, Rama, Carter, Michael J., O'Connor, Daniel, Bibi, Sagida, Kelly, Dominic F., Gurung, Meeru, Throson, Stephen, Ansari, Imran, Murdoch, David R., Shrestha, Shrijana, Oliver, Zoe, Lim, Emma, Valentine, Lucille, Allen, Karen, Bell, Kathryn, Chan, Adora, Crulley, Stephen, Devine, Kirsty, Fabian, Daniel, King, Sharon, McAlinden, Paul, McDonald, Sam, McDonell, Anne, Pickering, Alisa, Thomson, Evelyn, Wood, Amanda, Wallia, Diane, Woodsford, Phil, Baxter, Frances, Bell, Ashley, Rhodes, Mathew, Agbeko, Rachel, Mackerness, Christine, Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, Arif, Tasnim, Bennet, Joshua, Collings, Kalvin, Van der Giessen, Ilona, Martin, Alex, Rashid, Aqeela, Rowlands, Emily, Soon, Joshua, De Vries, Gabriella, van der Velden, Fabian, Martin, Mike, Mistry, Ravi, Zwerenz, Manuela, Buschbeck, Judith, Bidlingmaier, Christoph, Binder, Vera, Danhauser, Katharina, Haas, Nikolaus, Griese, Matthias, Kappler, Matthias, Lurz, Eberhard, Muench, Georg, Reiter, Karl, Schoen, Carola, Pachot, Alexandre, Mommert, Marine, Srovin, Tina Plankar, Bahovec, Natalija, Prunk, Petra, Osterman, Veronika, Avramoska, Tanja, Jongerius, Ilse, van den Berg, J.M., Schonenberg, D., Barendregt, A.M., Pajkrt, D., van der Kuip, M., van Furth, A.M., Sprenkeler, Evelien, Zandstra, Judith, van Mierlo, G., Geissler, J., Rivero-Calle, Irene, Sagmeister, Manfred G., Schweintzger, Nina A., Kuijpers, Taco W., van der Flier, Michiel, and von Both, Ulrich

Published
2023
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4. Impact of infection on proteome-wide glycosylation revealed by distinct signatures for bacterial and viral pathogens

Author

Abdulla, Amina, Aebi, Christoph, van Aerde, Koen, Agbeko, Rachel, Agyeman, Philipp, D’alessandro, Umberto, Ali, Ladan, Alkema, Wynand, Allen, Karen, González, Fernando Álvez, Anderson, Suzanne, Ansari, Imran, Araf, Tasnim, Avramoska, Tanja, Baas, Bryan, Bahovec, Natalija, Farto, Cristina Balo, Balode, Anda, Barendregt, A.M., Barral-Arca, Ruth, Castro, María Barreiro, Bārzdiņa, Arta, Bath, David, Bauchinger, Sebastian, Baumard, Lucas, Baumgart, Hinrich, Baxter, Frances, Bell, Ashley, Bell, Kathryn, Bello, Xabier, Bellos, Evangelos, Benesch, Martin, Ben García, Mirian, Bennet, Joshua, Berger, Christoph, van den Berg, J.M., Bernhard-Stirnemann, Sara, Bibi, Sagida, Bidlingmaier, Christoph, Binder, Alexander, Binder, Vera, Bojang, Kalifa, Borensztajn, Dorine M., von Both, Ulrich, Brengel-Pesce, Karen, van den Broek, Bryan, Buschbeck, Judith, Calvo-Bado, Leo, Carnota, Sandra, Carrol, Enitan D., Carter, Michael J., Cebey-López, Miriam, Ceesay, Samba, Ceolotto, Astrid, Chan, Adora, Cocklin, Elizabeth, Collings, Kalvin, Crulley, Stephen, Cunnington, Aubrey, Curras-Tuala, María José, Danhauser, Katharina, Darboe, Saffiatou, Darnell, Sarah, De, Tisham, Deksne, Dārta, Devine, Kirsty, Dewez, Juan Emmanuel, Dudley, Julia, Suárez, Carlos Durán, Eber, Ernst, Eleftheriou, Irini, Emonts, Marieke, Fabian, Daniel, Feuchtinger, Tobias, Fidler, Katy, Fink, Colin, van der Flier, Michiel, van Furth, A.M., Galassini, Rachel, Gallistl, Siegfried, Vicente, Luisa García, Gardovska, Dace, Geissler, J., Gerrits, G.P.J.M., Giannoni, Eric, van der Giessen, Ilona, Gloerich, Jolein, Gómez-Carballa, Alberto, Rial, Jose Gómez, van Gool, Alain J., Gores, Gunther, Grāvele, Dagne, Griese, Matthias, Grope, Ilze, de Groot, Ronald, Gurung, Meeru, de Haan, L., Haas, Nikolaus, Habgood-Coote, Dominic, Hagedoorn, Nienke N., Haidl, Harald, Hamilton, Shea, Hauer, Almuthe, Heidema, J., Heininger, Ulrich, Henriet, Stefanie, Herberg, Jethro, Hoggart, Clive, Hösele, Susanne, Hourmat, Sara, Hude, Christa, Huijnen, Martijn, Jackson, Heather, Jennings, Rebecca, Johnston, Joanne, de Jonge, Marien I., Jongerius, Ilse, Jorgensen, Rikke, Kaforou, Myrsini, Kahlert, Christian, Kandasamy, Rama, Kappler, Matthias, Keil, Julia, Keldorfer, Markus, Kell, Dominic F., Kim, Eunjung, King, Sharon, Kloosterhuis, Lieke, Kohlfürst, Daniela S., Kohlmaier, Benno, Kolberg, Laura, Kolnik, Mojca, Krenn, Larissa, Kuijpers, Taco, van der Kuip, M., Iglesias, Pilar Leboráns, Leigh, Simon, Leitner, Manuel, van Leur, M., Lim, Emma, Lin, Naomi, Liu, Ching-Chuan, Löffler, Sabine, Lurz, Eberhard, Maconochie, Ian, Mackerness, Christine, Mallet, François, Martinón-Torres, Federico, Marmarinos, Antonis, Martin, Alex, Martin, Mike, Martinón Sánchez, José María, Martinón-Torres, Nazareth, McAlinden, Paul, McDonnell, Anne, McDonald, Sam, Miedema, C.J., Meiere, Anija, Menikou, Stephanie, van Mierlo, G., Miners, Alec, Mistry, Ravi, Moll, Henriëtte A., Mommert, Marine, Pérez, Belén Mosquera, Murdoch, David R., Mustafa, Sobia, Natalucci, Giancarlo, Neeleman, C., Newall, Karen, Nichols, Samuel, Niedrist, Tobias, Niederer-Loher, Anita, Nijman, Ruud, Nokalna, Ieva, Urbāne, Urzula Nora, Nordberg, Gudrun, Obihara, C.C., O'Connor, Daniel, Oosthoek, Wilma, Osterman, Veronika, Pachot, Alexandre, Pajkrt, D., Pardo-Seco, Jacobo, Paulus, Stéphane, Pavāre, Jana, Paz, Ivonne Pena, Persand, Salina, Pfleger, Andreas, Pfurtscheller, Klaus, Philipsen, Ria, Pickering, Ailsa, Pierce, Benjamin, Pilch, Heidemarie, Rodríguez, Lidia Piñeiro, Pischedda, Sara, Srovin, Tina Plankar, Pokorn, Marko, Pollard, Andrew J., Pölz, Lena, Posfay-Barbe, Klara M., Prunk, Petra, Pučuka, Zanda, Rajic, Glorija, Rashid, Aqeela, Redondo-Collazo, Lorenzo, Relly, Christa, Calle, Irene Rivero, Vázquez, Sara Rey, Rhodes, Mathew, Richmond, Vivien, Riedel, Thomas, RocaIsatou Sarr, Anna, Rödl, Siegfried, Rodríguez-Tenreiro, Carmen, Romaine, Sam, Rowlands, Emily, Ora, Miguel Sadiki, Sagmeister, Manfred G., Saidykhan, Momodou, Salas, Antonio, Schlapbach, Luregn J., Schonenberg, D., Secka, Fatou, Selecka, Katrīna, Fernández, Sonia Serén, Trasorras, Cristina Serén, Shah, Priyen, Shen, Ching-Fen, Shrestha, Shrijana, Sidorova, Aleksandra, Skrabl-Baumgartner, Andrea, D’Souza, Giselle, Sperl, Matthias, Sprenkeler, Evelien, Schweintzger, Nina A., Stampfer, Laura, Stevens, Molly, Stocker, Martin, Strenger, Volker, Svile, Dace, Syggelou, Kelly, Tambouratzi, Maria, Tan, Chantal, Tavliavini, Emma, Thomson, Evelyn, Thorson, Stephen, Till, Holger, Tramper-Stranders, G.A., Trobisch, Andreas, Tsolia, Maria, Usuf, Effua, Valentine, Lucille, Vermont, Clementien L., Iglesias, Marisol Vilas, Vincek, Katarina, Voice, Marie, de Vries, Gabriella, Wallia, Diane, Wang, Shih-Min, Willems, Esther, Wilson, Clare, Wood, Amanda, Woodsford, Phil, Wright, Victoria, Xagorari, Marietta, Yeung, Shunmay, Zachariasse, Joany, Zavadska, Dace, Zaman, Syed M.A., Zandstra, Judith, Zenz, Werner, Zurl, Christoph, Zwerenz, Manuela, Suppers, Anouk, van den Heuvel, Lambert P., van de Kar, Nicole, Philipsen, Ria H.L.A., van Dael, Maurice, Wright, Victoria J., Herberg, Jethro A., Torres, Federico Martinon, Levin, Michael, Lefeber, Dirk J., and Wessels, Hans J.C.T.

Published
2023
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5. Febrile children with comorbidities at the emergency department — a multicentre observational study

Author

Borensztajn, Dorine M., Hagedoorn, Nienke N., Carrol, Enitan D., von Both, Ulrich, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael, Lim, Emma, Maconochie, Ian K., Martinon-Torres, Federico, Nijman, Ruud G., Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, van der Velden, Fabian J. S., Vermont, Clementien, Zavadska, Dace, Zenz, Werner, Zachariasse, Joany M., and Moll, Henriette A.

Published
2022
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9. Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

Author

Nijman, Ruud G., Honeyford, Kate, Farrugia, Ruth, Rose, Katy, Bognar, Zsolt, Buonsenso, Danilo, Da Dalt, Liviana, De, Tisham, Maconochie, Ian K., Parri, Niccolo, Roland, Damian, Alfven, Tobias, Aupiais, Camille, Barrett, Michael, Basmaci, Romain, Borensztajn, Dorine, Castanhinha, Susana, Vasilico, Corrine, Durnin, Sheena, Fitzpatrick, Paddy, Fodor, Laszlo, Gomez, Borja, Greber-Platzer, Susanne, Guedj, Romain, Hartshorn, Stuart, Hey, Florian, Jankauskaite, Lina, Kohlfuerst, Daniela, Kolnik, Mojca, Lyttle, Mark D., Mação, Patrícia, Mascarenhas, Maria Inês, Messahel, Shrouk, Özkan, Esra Akyüz, Pucuka, Zanda, Reis, Sofia, Rybak, Alexis, Ryd Rinder, Malin, Teksam, Ozlem, Turan, Caner, Thors, Valtýr Stefánsson, Velasco, Roberto, Bressan, Silvia, Moll, Henriette A., Oostenbrink, Rianne, and Titomanlio, Luigi

Subjects
Epidemics -- Influence, Pediatric emergencies -- Forecasts and trends, Market trend/market analysis, Biological sciences
Abstract

Background During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Methods and findings Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2·26, 95% CI 1·90 to 2·70, p < 0.001) and in children aged Conclusions Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. Trial registration ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258., Author(s): Ruud G. Nijman 1,2,3,*, Kate Honeyford 4, Ruth Farrugia 5, Katy Rose 1,6, Zsolt Bognar 7, Danilo Buonsenso 8,9, Liviana Da Dalt 10, Tisham De 2, Ian K. Maconochie [...]

Published
2022
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10. Rapid Viral Testing and Antibiotic Prescription in Febrile Children With Respiratory Symptoms Visiting Emergency Departments in Europe

Author

Tan, Chantal D., Hagedoorn, Nienke N., Dewez, Juan E., Borensztajn, Dorine M., von Both, Ulrich, Carrol, Enitan D., Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael, Lim, Emma, Maconochie, Ian K., Martinon-Torres, Federico, Nijman, Ruud G., Pokorn, Marko, Rivero-Calle, Irene, Strle, Franc, Tsolia, Maria, Vermont, Clementien L., Yeung, Shunmay, Zachariasse, Joany M., Zenz, Werner, Zavadska, Dace, and Moll, Henriette A.

Published
2022
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11. Impact of infection on proteome-wide glycosylation revealed by distinct signatures for bacterial and viral pathogens

Author

Willems, Esther, primary, Gloerich, Jolein, additional, Suppers, Anouk, additional, van der Flier, Michiel, additional, van den Heuvel, Lambert P., additional, van de Kar, Nicole, additional, Philipsen, Ria H.L.A., additional, van Dael, Maurice, additional, Kaforou, Myrsini, additional, Wright, Victoria J., additional, Herberg, Jethro A., additional, Torres, Federico Martinon, additional, Levin, Michael, additional, de Groot, Ronald, additional, van Gool, Alain J., additional, Lefeber, Dirk J., additional, Wessels, Hans J.C.T., additional, de Jonge, Marien I., additional, Abdulla, Amina, additional, Aebi, Christoph, additional, van Aerde, Koen, additional, Agbeko, Rachel, additional, Agyeman, Philipp, additional, D’alessandro, Umberto, additional, Ali, Ladan, additional, Alkema, Wynand, additional, Allen, Karen, additional, González, Fernando Álvez, additional, Anderson, Suzanne, additional, Ansari, Imran, additional, Araf, Tasnim, additional, Avramoska, Tanja, additional, Baas, Bryan, additional, Bahovec, Natalija, additional, Farto, Cristina Balo, additional, Balode, Anda, additional, Barendregt, A.M., additional, Barral-Arca, Ruth, additional, Castro, María Barreiro, additional, Bārzdiņa, Arta, additional, Bath, David, additional, Bauchinger, Sebastian, additional, Baumard, Lucas, additional, Baumgart, Hinrich, additional, Baxter, Frances, additional, Bell, Ashley, additional, Bell, Kathryn, additional, Bello, Xabier, additional, Bellos, Evangelos, additional, Benesch, Martin, additional, Ben García, Mirian, additional, Bennet, Joshua, additional, Berger, Christoph, additional, van den Berg, J.M., additional, Bernhard-Stirnemann, Sara, additional, Bibi, Sagida, additional, Bidlingmaier, Christoph, additional, Binder, Alexander, additional, Binder, Vera, additional, Bojang, Kalifa, additional, Borensztajn, Dorine M., additional, von Both, Ulrich, additional, Brengel-Pesce, Karen, additional, van den Broek, Bryan, additional, Buschbeck, Judith, additional, Calvo-Bado, Leo, additional, Carnota, Sandra, additional, Carrol, Enitan D., additional, Carter, Michael J., additional, Cebey-López, Miriam, additional, Ceesay, Samba, additional, Ceolotto, Astrid, additional, Chan, Adora, additional, Cocklin, Elizabeth, additional, Collings, Kalvin, additional, Crulley, Stephen, additional, Cunnington, Aubrey, additional, Curras-Tuala, María José, additional, Danhauser, Katharina, additional, Darboe, Saffiatou, additional, Darnell, Sarah, additional, De, Tisham, additional, Deksne, Dārta, additional, Devine, Kirsty, additional, Dewez, Juan Emmanuel, additional, Dudley, Julia, additional, Suárez, Carlos Durán, additional, Eber, Ernst, additional, Eleftheriou, Irini, additional, Emonts, Marieke, additional, Fabian, Daniel, additional, Feuchtinger, Tobias, additional, Fidler, Katy, additional, Fink, Colin, additional, van Furth, A.M., additional, Galassini, Rachel, additional, Gallistl, Siegfried, additional, Vicente, Luisa García, additional, Gardovska, Dace, additional, Geissler, J., additional, Gerrits, G.P.J.M., additional, Giannoni, Eric, additional, van der Giessen, Ilona, additional, Gómez-Carballa, Alberto, additional, Rial, Jose Gómez, additional, Gores, Gunther, additional, Grāvele, Dagne, additional, Griese, Matthias, additional, Grope, Ilze, additional, Gurung, Meeru, additional, de Haan, L., additional, Haas, Nikolaus, additional, Habgood-Coote, Dominic, additional, Hagedoorn, Nienke N., additional, Haidl, Harald, additional, Hamilton, Shea, additional, Hauer, Almuthe, additional, Heidema, J., additional, Heininger, Ulrich, additional, Henriet, Stefanie, additional, Herberg, Jethro, additional, Hoggart, Clive, additional, Hösele, Susanne, additional, Hourmat, Sara, additional, Hude, Christa, additional, Huijnen, Martijn, additional, Jackson, Heather, additional, Jennings, Rebecca, additional, Johnston, Joanne, additional, Jongerius, Ilse, additional, Jorgensen, Rikke, additional, Kahlert, Christian, additional, Kandasamy, Rama, additional, Kappler, Matthias, additional, Keil, Julia, additional, Keldorfer, Markus, additional, Kell, Dominic F., additional, Kim, Eunjung, additional, King, Sharon, additional, Kloosterhuis, Lieke, additional, Kohlfürst, Daniela S., additional, Kohlmaier, Benno, additional, Kolberg, Laura, additional, Kolnik, Mojca, additional, Krenn, Larissa, additional, Kuijpers, Taco, additional, van der Kuip, M., additional, Iglesias, Pilar Leboráns, additional, Leigh, Simon, additional, Leitner, Manuel, additional, van Leur, M., additional, Lim, Emma, additional, Lin, Naomi, additional, Liu, Ching-Chuan, additional, Löffler, Sabine, additional, Lurz, Eberhard, additional, Maconochie, Ian, additional, Mackerness, Christine, additional, Mallet, François, additional, Martinón-Torres, Federico, additional, Marmarinos, Antonis, additional, Martin, Alex, additional, Martin, Mike, additional, Martinón Sánchez, José María, additional, Martinón-Torres, Nazareth, additional, McAlinden, Paul, additional, McDonnell, Anne, additional, McDonald, Sam, additional, Miedema, C.J., additional, Meiere, Anija, additional, Menikou, Stephanie, additional, van Mierlo, G., additional, Miners, Alec, additional, Mistry, Ravi, additional, Moll, Henriëtte A., additional, Mommert, Marine, additional, Pérez, Belén Mosquera, additional, Murdoch, David R., additional, Mustafa, Sobia, additional, Natalucci, Giancarlo, additional, Neeleman, C., additional, Newall, Karen, additional, Nichols, Samuel, additional, Niedrist, Tobias, additional, Niederer-Loher, Anita, additional, Nijman, Ruud, additional, Nokalna, Ieva, additional, Urbāne, Urzula Nora, additional, Nordberg, Gudrun, additional, Obihara, C.C., additional, O'Connor, Daniel, additional, Oosthoek, Wilma, additional, Osterman, Veronika, additional, Pachot, Alexandre, additional, Pajkrt, D., additional, Pardo-Seco, Jacobo, additional, Paulus, Stéphane, additional, Pavāre, Jana, additional, Paz, Ivonne Pena, additional, Persand, Salina, additional, Pfleger, Andreas, additional, Pfurtscheller, Klaus, additional, Philipsen, Ria, additional, Pickering, Ailsa, additional, Pierce, Benjamin, additional, Pilch, Heidemarie, additional, Rodríguez, Lidia Piñeiro, additional, Pischedda, Sara, additional, Srovin, Tina Plankar, additional, Pokorn, Marko, additional, Pollard, Andrew J., additional, Pölz, Lena, additional, Posfay-Barbe, Klara M., additional, Prunk, Petra, additional, Pučuka, Zanda, additional, Rajic, Glorija, additional, Rashid, Aqeela, additional, Redondo-Collazo, Lorenzo, additional, Relly, Christa, additional, Calle, Irene Rivero, additional, Vázquez, Sara Rey, additional, Rhodes, Mathew, additional, Richmond, Vivien, additional, Riedel, Thomas, additional, RocaIsatou Sarr, Anna, additional, Rödl, Siegfried, additional, Rodríguez-Tenreiro, Carmen, additional, Romaine, Sam, additional, Rowlands, Emily, additional, Ora, Miguel Sadiki, additional, Sagmeister, Manfred G., additional, Saidykhan, Momodou, additional, Salas, Antonio, additional, Schlapbach, Luregn J., additional, Schonenberg, D., additional, Secka, Fatou, additional, Selecka, Katrīna, additional, Fernández, Sonia Serén, additional, Trasorras, Cristina Serén, additional, Shah, Priyen, additional, Shen, Ching-Fen, additional, Shrestha, Shrijana, additional, Sidorova, Aleksandra, additional, Skrabl-Baumgartner, Andrea, additional, D’Souza, Giselle, additional, Sperl, Matthias, additional, Sprenkeler, Evelien, additional, Schweintzger, Nina A., additional, Stampfer, Laura, additional, Stevens, Molly, additional, Stocker, Martin, additional, Strenger, Volker, additional, Svile, Dace, additional, Syggelou, Kelly, additional, Tambouratzi, Maria, additional, Tan, Chantal, additional, Tavliavini, Emma, additional, Thomson, Evelyn, additional, Thorson, Stephen, additional, Till, Holger, additional, Tramper-Stranders, G.A., additional, Trobisch, Andreas, additional, Tsolia, Maria, additional, Usuf, Effua, additional, Valentine, Lucille, additional, Vermont, Clementien L., additional, Iglesias, Marisol Vilas, additional, Vincek, Katarina, additional, Voice, Marie, additional, de Vries, Gabriella, additional, Wallia, Diane, additional, Wang, Shih-Min, additional, Willems, Esther, additional, Wilson, Clare, additional, Wood, Amanda, additional, Woodsford, Phil, additional, Wright, Victoria, additional, Xagorari, Marietta, additional, Yeung, Shunmay, additional, Zachariasse, Joany, additional, Zavadska, Dace, additional, Zaman, Syed M.A., additional, Zandstra, Judith, additional, Zenz, Werner, additional, Zurl, Christoph, additional, and Zwerenz, Manuela, additional

Published
2023
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12. Adeno-associated virus 2 infection in children with non-A–E hepatitis

Author

Ho, Antonia, Orton, Richard, Tayler, Rachel, Asamaphan, Patawee, Herder, Vanessa, Davis, Chris, Tong, Lily, Smollett, Katherine, Manali, Maria, Allan, Jay, Rawlik, Konrad, McDonald, Sarah E., Vink, Elen, Pollock, Louisa, Gannon, Louise, Evans, Clair, McMenamin, Jim, Roy, Kirsty, Marsh, Kimberly, Divala, Titus, Holden, Matthew T.G., Lockhart, Michael, Yirrell, David, Currie, Sandra, O’Leary, Maureen, Henderson, David, Shepherd, Samantha J., Jackson, Celia, Gunson, Rory, MacLean, Alasdair, McInnes, Neil, Bradley-Stewart, Amanda, Battle, Richard, Hollenbach, Jill A., Henderson, Paul, Nijman, Ruud, Peters, Mark, Emonts, Marieke, van der Zee, Carlijn C.W., Vermont, Clementien L., Moll, Henriëtte A., Borensztajn, Dorine M., Hagedoorn, Nienke N., Tan, Chantal, Zachariasse, Joany, Dik, W., van der Flier, Michiel, Stocker, Martin, Tempel, Dennie, Hoffmann, Florian, Pediatrics, Erasmus MC other, Rehabilitation Medicine, Immunology, Cardiology, and Business Economics

Subjects
SDG 3 - Good Health and Well-being
Abstract

An outbreak of acute hepatitis of unknown aetiology in children was reported in Scotland 1 in April 2022 and has now been identified in 35 countries 2. Several recent studies have suggested an association with human adenovirus with this outbreak, a virus not commonly associated with hepatitis. Here we report a detailed case–control investigation and find an association between adeno-associated virus 2 (AAV2) infection and host genetics in disease susceptibility. Using next-generation sequencing, PCR with reverse transcription, serology and in situ hybridization, we detected recent infection with AAV2 in plasma and liver samples in 26 out of 32 (81%) cases of hepatitis compared with 5 out of 74 (7%) of samples from unaffected individuals. Furthermore, AAV2 was detected within ballooned hepatocytes alongside a prominent T cell infiltrate in liver biopsy samples. In keeping with a CD4+ T-cell-mediated immune pathology, the human leukocyte antigen (HLA) class II HLA-DRB1*04:01 allele was identified in 25 out of 27 cases (93%) compared with a background frequency of 10 out of 64 (16%; P = 5.49 × 10−12). In summary, we report an outbreak of acute paediatric hepatitis associated with AAV2 infection (most likely acquired as a co-infection with human adenovirus that is usually required as a ‘helper virus’ to support AAV2 replication) and disease susceptibility related to HLA class II status.

Published
2023

13. Genomic investigations of unexplained acute hepatitis in children

Author

Morfopoulou, Sofia, Buddle, Sarah, Torres Montaguth, Oscar Enrique, Atkinson, Laura, Guerra-Assunção, José Afonso, Moradi Marjaneh, Mahdi, Zennezini Chiozzi, Riccardo, Storey, Nathaniel, Campos, Luis, Hutchinson, J. Ciaran, Counsell, John R., Pollara, Gabriele, Roy, Sunando, Venturini, Cristina, Antinao Diaz, Juan F., Siam, Ala’a, Tappouni, Luke J., Asgarian, Zeinab, Ng, Joanne, Hanlon, Killian S., Lennon, Alexander, McArdle, Andrew, Nijman, Ruud, Peters, Mark, Emonts, Marieke, van der Zee, Carlijn, Vermont, Clementien L., Moll, Henriëtte A., Borensztajn, Dorine M., Hagedoorn, Nienke N., Tan, Chantal, Zachariasse, Joany, Dik, W., van der Flier, Michiel, Stocker, Martin, Tempel, Dennie, Hoffmann, Florian, de Groot, Ronald, Willems, Esther, de Haan, L., Neeleman, C., Tramper-Stranders, G. A., Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, de Vries, Gabriella, van den Berg, J. M., Barendregt, A. M., Breuer, Judith, Pediatrics, Erasmus MC other, Rehabilitation Medicine, Immunology, Cardiology, Business Economics, Erasmus School of Economics, Radiotherapy, Economics, Obstetrics & Gynecology, Psychiatry, and BV's

Subjects
SDG 3 - Good Health and Well-being
Abstract

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

Published
2023

14. European study confirms the combination of fever and petechial rash as an important warning sign for childhood sepsis and meningitis

Author

Kohlmaier, Benno, Leitner, Manuel, Hagedoorn, Nienke N., Borensztajn, Dorine M., von Both, Ulrich, Carrol, Enitan D., Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Levin, Michael, Lim, Emma, Maconochie, Ian K., Martinon-Torres, Federico, Nijman, Ruud G., Pokorn, Marko, Rivero-Calle, Irene, Tan, Chantal D., Tsolia, Maria, Vermont, Clementien L., Zachariasse, Joany M., Zavadska, Dace, Moll, Henriette A., Zenz, Werner, and Pediatrics

Subjects
All institutes and research themes of the Radboud University Medical Center, Pediatrics, Perinatology and Child Health, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], General Medicine
Abstract

Contains fulltext : 291888.pdf (Publisher’s version ) (Open Access) AIM: This study investigated febrile children with petechial rashes who presented to European emergency departments (EDs) and investigated the role that mechanical causes played in diagnoses. METHODS: Consecutive patients with fever presenting to EDs in 11 European emergency departments in 2017-2018 were enrolled. The cause and focus of infection were identified and a detailed analysis was performed on children with petechial rashes. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: We found that 453/34010 (1.3%) febrile children had petechial rashes. The focus of the infection included sepsis (10/453, 2.2%) and meningitis (14/453, 3.1%). Children with a petechial rash were more likely than other febrile children to have sepsis or meningitis (OR 8.5, 95% CI 5.3-13.1) and bacterial infections (OR 1.4, 95% CI 1.0-1.8) as well as need for immediate life-saving interventions (OR 6.6, 95% CI 4.4-9.5) and intensive care unit admissions (OR 6.5, 95% CI 3.0-12.5). CONCLUSION: The combination of fever and petechial rash is still an important warning sign for childhood sepsis and meningitis. Ruling out coughing and/or vomiting was insufficient to safely identify low-risk patients.

Published
2023

15. Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians

Author

Dewez, Juan Emmanuel, primary, Pembrey, Lucy, additional, Nijman, Ruud G., additional, del Torso, Stefano, additional, Grossman, Zachi, additional, Hadjipanayis, Adamos, additional, Van Esso, Diego, additional, Lim, Emma, additional, Emonts, Marieke, additional, Burns, James, additional, Gras-LeGuen, Christèle, additional, Kohlfuerst, Daniela, additional, Dornbusch, Hans Jürgen, additional, Brengel-Pesce, Karen, additional, Mallet, Francois, additional, von Both, Ulrich, additional, Tsolia, Maria, additional, Eleftheriou, Irini, additional, Zavadska, Dace, additional, de Groot, Ronald, additional, van der Flier, Michiel, additional, Moll, Henriëtte, additional, Hagedoorn, Nienke, additional, Borensztajn, Dorine, additional, Oostenbrink, Rianne, additional, Kuijpers, Taco, additional, Pokorn, Marko, additional, Vincek, Katarina, additional, Martinón-Torres, Federico, additional, Rivero, Irene, additional, Agyeman, Philipp, additional, Carrol, Enitan D., additional, Paulus, Stéphane, additional, Cunnington, Aubrey, additional, Herberg, Jethro, additional, Levin, Michael, additional, Mujkić, Aida, additional, Geitmann, Karin, additional, Da Dalt, Liviana, additional, Valiulis, Arūnas, additional, Lapatto, Risto, additional, Syridou, Garyfallia, additional, Altorjai, Péter, additional, Torpiano, Paul, additional, Størdal, Ketil, additional, Illy, Károly, additional, Mazur, Artur, additional, Spreitzer, Mateja Vintar, additional, Rios, Joana, additional, Wyder, Corinne, additional, Romankevych, Ivanna, additional, Basmaci, Romain, additional, Ibanez-Mico, Salvador, additional, and Yeung, Shunmay, additional

Published
2022
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16. INCREASE IN INVASIVE GROUP A STREPTOCOCCAL INFECTIONS IN CHILDREN IN THE NETHERLANDS, A SURVEY AMONG 7 HOSPITALS IN 2022

Author

van Kempen, Evelien B., primary, Bruijning-Verhagen, Patricia C.J., additional, Borensztajn, Dorine, additional, Vermont, Clementien L., additional, Quaak, Marjolijn S.W., additional, Janson, Jo-Anne, additional, Maat, Ianthe, additional, Stol, Kim, additional, Vlaminckx, Bart J.M., additional, Wieringa, Jantien W., additional, van Sorge, Nina M., additional, Boeddha, Navin P., additional, and van Veen, Mirjam, additional

Published
2022
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17. Paediatric Emergency Medicine: Improving the patient’s journey at the Emergency Department

Author

Borensztajn, Dorine, Moll, Henriette, van der Lei, Johan, and Pediatrics

Abstract

This dissertation, which studied data of 140,000 European children, aims to improve the care for children at the ED by identifying areas with wide practice variation, by identifying children at risk for a complicated disease course such as intensive care admission and by improving patient flow.

Published
2022

18. Febrile illness in high-risk children: a prospective, international observational study

Author

van der Velden, Fabian J. S., de Vries, Gabriella, Martin, Alexander, Lim, Emma, von Both, Ulrich, Kolberg, Laura, Carrol, Enitan D., Khanijau, Aakash, Herberg, Jethro A., De, Tisham, Galassini, Rachel, Kuijpers, Taco W., Martinón-Torres, Federico, Rivero-Calle, Irene, Vermont, Clementien L., Hagedoorn, Nienke N., Pokorn, Marko, Pollard, Andrew J., Schlapbach, Luregn J., Tsolia, Maria, Elefhteriou, Irini, Yeung, Shunmay, Zavadska, Dace, Fink, Colin, Voice, Marie, Zenz, Werner, Kohlmaier, Benno, Agyeman, Philipp K. A., Usuf, Effua, Secka, Fatou, de Groot, Ronald, Levin, Michael, van der Flier, Michiel, Emonts, Marieke, Cunnington, Aubrey, Herberg, Jethro, Kaforou, Myrsini, Wright, Victoria, Baumard, Lucas, Bellos, Evangelos, D’Souza, Giselle, Habgood-Coote, Dominic, Hamilton, Shea, Hoggart, Clive, Hourmat, Sara, Jackson, Heather, Maconochie, Ian, Menikou, Stephanie, Lin, Naomi, Nichols, Samuel, Nijman, Ruud, Powell, Oliver, Pena Paz, Ivonne, Shah, Priyen, Shen, Ching-Fen, Vito, Ortensia, Wilson, Clare, Abdulla, Amina, Ali, Ladan, Darnell, Sarah, Jorgensen, Rikke, Mustafa, Sobia, Persand, Salina, Stevens, Molly M., Kim, Nayoung, Kim, Eunjung, Fidler, Katy, Dudley, Julia, Richmond, Vivien, Tavliavini, Emma, Liu, Ching-Chuan, Wang, Shih-Min, Salas, Antonio, Álvez González, Fernando, Balo Farto, Cristina, Barral-Arca, Ruth, Barreiro Castro, María, Bello, Xabier, García, Mirian Ben, Carnota, Sandra, Cebey-López, Miriam, Curras-Tuala, María José, Durán Suárez, Carlos, García Vicente, Luisa, Gómez-Carballa, Alberto, Gómez Rial, Jose, Leboráns Iglesias, Pilar, Martinón-Torres, Nazareth, Martinón Sánchez, José María, Mosquera Pérez, Belén, Pardo-Seco, Jacobo, Rodríguez, Lidia Piñeiro, Pischedda, Sara, Vázquez, Sara Rey, Rivero Calle, Irene, Rodríguez-Tenreiro, Carmen, Redondo-Collazo, Lorenzo, Sadiki Ora, Miguel, Serén Fernández, Sonia, Serén Trasorras, Cristina, Vilas Iglesias, Marisol, Balode, Anda, Bārzdiņa, Arta, Deksne, Dārta, Gardovska, Dace, Grāvele, Dagne, Grope, Ilze, Meiere, Anija, Nokalna, Ieva, Pavāre, Jana, Pučuka, Zanda, Selecka, Katrīna, Rudzāte, Aleksandra, Svile, Dace, Urbāne, Urzula Nora, Bojang, Kalifa, Zaman, Syed M. A., Anderson, Suzanne, RocaIsatou Sarr, Anna, Saidykhan, Momodou, Darboe, Saffiatou, Ceesay, Samba, D’alessandro, Umberto, Moll, Henriëtte A., Vermont, Clementien L, Borensztajn, Dorine M., Tan, Chantal, Zachariasse, Joany, Dik, W, Agyeman, Philipp KA, Berger, Christoph, Giannoni, Eric, Stocker, Martin, Posfay-Barbe, Klara M, Heininger, Ulrich, Bernhard-Stirnemann, Sara, Niederer-Loher, Anita, Kahlert, Christian R., Natalucci, Giancarlo, Relly, Christa, Riedel, Thomas, Aebi, Christoph, Schlapbach, Luregn J, Carrol, Enitan D, Cocklin, Elizabeth, Jennings, Rebecca, Johnston, Joanne, Leigh, Simon, Lewis-Burke, Nadia, Newall, Karen, Romaine, Sam, Eleftheriou, Irini, Tambouratzi, Maria, Marmarinos, Antonis, Xagorari, Marietta, Syggelou, Kelly, Calvo-Bado, Leo, Schweintzger, Nina A., Sagmeister, Manfred G., Kohlfürst, Daniela S., Zurl, Christoph, Binder, Alexander, Hösele, Susanne, Leitner, Manuel, Pölz, Lena, Rajic, Glorija, Bauchinger, Sebastian, Baumgart, Hinrich, Benesch, Martin, Ceolotto, Astrid, Eber, Ernst, Gallistl, Siegfried, Gores, Gunther, Haidl, Harald, Hauer, Almuthe, Hude, Christa, Keldorfer, Markus, Krenn, Larissa, Pilch, Heidemarie, Pfleger, Andreas, Pfurtscheller, Klaus, Nordberg, Gudrun, Niedrist, Tobias, Rödl, Siegfried, Skrabl-Baumgartner, Andrea, Sperl, Matthias, Stampfer, Laura, Strenger, Volker, Till, Holger, Trobisch, Andreas, Löffler, Sabine, Dewez, Juan Emmanuel, Hibberd, Martin, Bath, David, Miners, Alec, Fitchett, Elizabeth, de Jonge, Marien I., van Aerde, Koen, Alkema, Wynand, van den Broek, Bryan, Gloerich, Jolein, van Gool, Alain J., Henriet, Stefanie, Huijnen, Martijn, Philipsen, Ria, Willems, Esther, Gerrits, G.P.J.M., van Leur, M., Heidema, J., de Haan, L., Miedema, C.J., Neeleman, C., Obihara, C.C., Tramper-Stranders, G.A., Kandasamy, Rama, Paulus, Stéphane, Carter, Michael J., O’Connor, Daniel, Bibi, Sagida, Kelly, Dominic F., Gurung, Meeru, Thorson, Stephen, Ansari, Imran, Murdoch, David R., Shrestha, Shrijana, Oliver, Zoe, Valentine, Lucille, Allen, Karen, Bell, Kathryn, Chan, Adora, Crulley, Stephen, Devine, Kirsty, Fabian, Daniel, King, Sharon, McAlinden, Paul, McDonald, Sam, McDonnell, Anne, Pickering, Ailsa, Thomson, Evelyn, Wood, Amanda, Wallia, Diane, Woodsford, Phil, Baxter, Frances, Bell, Ashley, Rhodes, Mathew, Agbeko, Rachel, Mackerness, Christine, Baas, Bryan, Kloosterhuis, Lieke, Oosthoek, Wilma, Arif, Tasnim, Bennet, Joshua, Collings, Kalvin, van der Giessen, Ilona, Martin, Alex, Rashid, Aqeela, Rowlands, Emily, van der Velden, Fabian, Soon, Joshua, Martin, Mike, Mistry, Ravi, Zwerenz, Manuela, Buschbeck, Judith, Bidlingmaier, Christoph, Binder, Vera, Danhauser, Katharina, Haas, Nikolaus, Griese, Matthias, Feuchtinger, Tobias, Keil, Julia, Kappler, Matthias, Lurz, Eberhard, Muench, Georg, Reiter, Karl, Schoen, Carola, Mallet, François, Brengel-Pesce, Karen, Pachot, Alexandre, Mommert, Marine, Kolnik, Mojca, Vincek, Katarina, Srovin, Tina Plankar, Bahovec, Natalija, Prunk, Petra, Osterman, Veronika, Avramoska, Tanja, Kuijpers, Taco, Jongerius, Ilse, van den Berg, J. M., Schonenberg, D., Barendregt, A. M., Pajkrt, D., van der Kuip, M., van Furth, A. M., Sprenkeler, Evelien, Zandstra, Judith, van Mierlo, G., Geissler, J., consortium, PERFORM, Paediatric Infectious Diseases / Rheumatology / Immunology, AII - Infectious diseases, ARD - Amsterdam Reproduction and Development, and Pediatrics

Subjects
All institutes and research themes of the Radboud University Medical Center, Fever, SDG 3 - Good Health and Well-being, Antibiotics, Paediatric, Pediatrics, Perinatology and Child Health, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], 610 Medicine & health, Infection, 610 Medizin und Gesundheit, Immunocompromised
Abstract

To assess and describe the aetiology and management of febrile illness in children with primary or acquired immunodeficiency at high risk of serious bacterial infection, as seen in emergency departments in tertiary hospitals. Prospective data on demographics, presenting features, investigations, microbiology, management, and outcome of patients within the ‘Biomarker Validation in HR patients’ database in PERFORM, were analysed. Immunocompromised children (N = 492); 94.3% proven/presumed bacterial (N = 164), 66.1% proven/presumed viral (N = 84), and 93.2% unknown bacterial or viral infections (N = 177). Mortality was 1.9% (N = 11) and 87.1% made full recovery (N = 522). Conclusion: The aetiology of febrile illness in immunocompromised children is diverse. In one-third of cases, no cause for the fever will be identified. Justification for standard intravenous antibiotic treatment for every febrile immunocompromised child is debatable, yet effective. Better clinical decision-making tools and new biomarkers are needed for this population. What is Known:• Immunosuppressed children are at high risk for morbidity and mortality of serious bacterial and viral infection, but often present with fever as only clinical symptom.• Current diagnostic measures in this group are not specific to rule out bacterial infection, and positivity rates of microbiological cultures are low. What is New:• Febrile illness and infectious complications remain a significant cause of mortality and morbidity in HR children, yet management is effective.• The aetiology of febrile illness in immunocompromised children is diverse, and development of pathways for early discharge or cessation of intravenous antibiotics is debatable, and requires better clinical decision-making tools and biomarkers.

Published
2022

19. Shock Index in the early assessment of febrile children at the emergency

Author

Hagedoorn, Nienke N, Zachariasse, Joany M, Borensztajn, Dorine, Adriaansens, Elise, von Both, Ulrich, Carrol, Enitan D, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro Adam, Kohlmaier, Benno, Lim, Emma, Maconochie, Ian, Martinon-Torres, Federico, Nijman, Ruud Gerard, Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Zavadska, Dace, Zenz, Werner, Levin, Michael, Vermont, Clementien, Moll, Henriette A, and Consortium, PERFORM

Published
2022

20. Characteristics and management of adolescents attending the ED with fever: a prospective multicentre study

Author

Borensztajn, Dorine, Hagedoorn, Nienke N, Carrol, Enitan, von Both, Ulrich, Dewez, Juan Emmanuel, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Kohlmaier, Benno, Levin, Michael, Lim, Emma, Maconochie, Ian, Martinon Torres, Federico, Nijman, Ruud, Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Vermont, Clementien, Zavadska, Dace, Zenz, Werner, Zachariasse, Joany, Moll, Henriette A, PERFORM Consortium: Personalised Risk assessment in febrile chil, Pediatrics, and National Institute of Health and Medical Research

Subjects
Adolescent, Fever, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], CHILDREN, paediatric infectious disease & immunisation, 1117 Public Health and Health Services, Medicine, General & Internal, ADHERENCE, All institutes and research themes of the Radboud University Medical Center, General & Internal Medicine, EPIDEMIOLOGY, Humans, Prospective Studies, MENINGOCOCCAL DISEASE, PROCALCITONIN, Child, Science & Technology, SEPSIS, Vital Signs, RECOGNITION, Infant, 1103 Clinical Sciences, Paediatrics, General Medicine, Bacterial Infections, EMERGENCY-DEPARTMENT, INVASIVE BACTERIAL-INFECTIONS, PERFORM Consortium: Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union, Child, Preschool, Medicine, Emergency Service, Hospital, paediatric A&E and ambulatory care, Life Sciences & Biomedicine, 1199 Other Medical and Health Sciences
Abstract

ObjectiveMost studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED.Design and settingThe MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12–18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection).Results37 420 encounters were included, of which 2577 (6.9%) were adolescents. Adolescents were more often triaged as highly urgent (38.9% vs 34.5%) and described as ill appearing (23.1% vs 15.6%) than younger children. Increased work of breathing and a non-blanching rash were present less often in adolescents, while neurological signs were present more often (1% vs 0%). C reactive protein tests were performed more frequently in adolescents and were more often abnormal (adjusted OR (aOR) 1.7, 95% CI 1.5 to 1.9). Adolescents were more often diagnosed with SBI (OR 1.8, 95% CI 1.6 to 2.0) and sepsis/meningitis (OR 2.3, 95% CI 1.1 to 5.0) and were more frequently admitted (aOR 1.3, 95% CI 1.2 to 1.4) and treated with intravenous antibiotics (aOR 1.7, 95% CI 1.5 to 2.0).ConclusionsAlthough younger children presented to the ED more frequently, adolescents were more often diagnosed with SBI and sepsis/meningitis. Our data emphasise the importance of awareness of severe infections in adolescents.

Published
2022

21. Shock Index in the early assessment of febrile children at the emergency

Author

Hagedoorn, Nienke N. Zachariasse, Joany M. Borensztajn, Dorine and Adriaansens, Elise von Both, Ulrich Carrol, Enitan D. and Eleftheriou, Irini Emonts, Marieke van der Flier, Michiel de Groot, Ronald Herberg, Jethro Adam Kohlmaier, Benno Lim, Emma Maconochie, Ian Martinon-Torres, Federico Nijman, Ruud Gerard Pokorn, Marko Rivero-Calle, Irene Tsolia, Maria and Zavadska, Dace Zenz, Werner Levin, Michael Vermont, Clementien Moll, Henriette A. PERFORM Consortium

Abstract

EU multicentre ED study of presenting vital signs in >5000 febrile children with an association between “shock index” and serious illness, but low sensitivity limits utility in screening. Objective (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children. Design/setting Observational study in 11 European EDs (2017-2018). Patients Febrile children with measured blood pressure. Main outcome measures Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs). Results Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8. Conclusions High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.

Published
2022

22. Patterns of presentations of children to emergency departments across Europe and the impact of the COVID-19 pandemic: retrospective observational multinational study.

Author

Nijman, Ruud G, primary, Honeyford, Kate, additional, Farrugia, Ruth, additional, Rose, Katy, additional, Bognar, Zsolt, additional, Buonsenso, Danilo, additional, Da Dalt, Liviana, additional, De, Tisham, additional, Maconochie, Ian, additional, Parri, Niccolo, additional, Roland, Damian, additional, Alfven, Tobias, additional, Aupiais, Camille, additional, Barrett, Michael, additional, Basmaci, Romain, additional, Borensztajn, Dorine, additional, Castanhinha, Susana, additional, Vasilico, Corrine, additional, Durnin, Sheena, additional, Fitzpatrick, Patrick, additional, Fodor, Laszlo, additional, Gomez, Borja, additional, Greber-Platzer, Susanne, additional, Guedj, Romain, additional, Hartshorn, Stuart, additional, Hey, Florian, additional, Jankauskaite, Lina, additional, Kohlfuerst, Daniela, additional, Kolnik, Mojca, additional, Lyttle, Mark, additional, Macao, Patricia, additional, Mascarenhas, Maria Ines, additional, Messahel, Shrouk, additional, Ozkan, Esra, additional, Pucuka, Zanda, additional, Reis, Sofia, additional, Rybak, Alexis, additional, Ryd Rinder, Malin, additional, Teksam, Ozlem, additional, Turan, Caner, additional, Thors, Valtyr, additional, Velasco, Roberto, additional, Bressan, Silvia, additional, Moll, Henriette, additional, Oostenbrink, Rianne, additional, and Titomanlio, Luigi, additional

Published
2022
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23. Children with Fever and Petechial Rash Presenting to the Paediatric Emergency Department (ED): A European Multicentre Observational Study

Author

Kohlmaier, Benno, primary, Leitner, Manuel, additional, Hagedoorn, Nienke N., additional, Borensztajn, Dorine, additional, von Both, Ulrich, additional, Carrol, Enitan, additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, De Groot, Ronald, additional, Herberg, Jethro A., additional, Levin, Michael, additional, Lim, Emma, additional, Maconochie, Ian K., additional, Martinon-Torres, Federico, additional, Nijman, Ruud, additional, Pokorn, Marko, additional, Calle, Irene Rivero, additional, Tan, Chantal D., additional, Tsolia, Maria, additional, Vermont, Clementien, additional, Zachariasse, Joany M., additional, Zavadska, Dace, additional, Moll, Henriette, additional, and Zenz, Werner, additional

Published
2022
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24. Patterns of Presentations of Children to Emergency Departments Across Europe and the Impact of the COVID-19 Pandemic: Retrospective Observational Multinational Study

Author

Nijman, Ruud, primary, Honeyford, Kate, additional, Farrugia, Ruth, additional, Rose, Katy, additional, Bognár, Zsolt, additional, Buonsenso, Danilo, additional, Dadalt, Liviana, additional, De, Tisham, additional, Maconochie, Ian, additional, Parri, Niccolo, additional, Roland, Damian, additional, Alfven, Tobias, additional, Aupiais, Camille, additional, Barrett, Michael, additional, Basmaci, Romain, additional, Borensztajn, Dorine, additional, Castanhinha, Susana, additional, Corrine, Vasilico, additional, Durnin, Sheena, additional, Fitzpatrick, Paddy, additional, Fodor, Laszlo, additional, Gomez, Borja, additional, Greber-Platzer, Susanne, additional, Guedj, Romain, additional, Hartshorn, Stuart, additional, Hey, Florian, additional, Jankauskaite, Lina, additional, Kohlfuerst, Daniela, additional, Kolnik, Mojca, additional, Lyttle, Mark D., additional, Mação, Patrícia, additional, Mascarenhas, Maria Inês, additional, Messahel, Shrouk, additional, Özkan, Esra Akyüz, additional, Pučuka, Zanda, additional, Reis, Sofia, additional, Rybak, Alexis, additional, Ryd Rinder, Malin, additional, Teksam, Ozlem, additional, Turan, Caner, additional, Stefánsson Thors, Valtýr, additional, Velasco, Roberto, additional, Bressan, Silvia, additional, Moll, Henriette, additional, Oostenbrink, Rianne, additional, and Titomanlio, Luigi, additional

Published
2022
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25. Rapid Viral Testing and Antibiotic Prescription in Febrile Children With Respiratory Symptoms Visiting Emergency Departments in Europe

Author

Tan, Chantal D., primary, Hagedoorn, Nienke N., additional, Dewez, Juan E., additional, Borensztajn, Dorine M., additional, von Both, Ulrich, additional, Carrol, Enitan D., additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, de Groot, Ronald, additional, Herberg, Jethro, additional, Kohlmaier, Benno, additional, Levin, Michael, additional, Lim, Emma, additional, Maconochie, Ian K., additional, Martinon-Torres, Federico, additional, Nijman, Ruud G., additional, Pokorn, Marko, additional, Rivero-Calle, Irene, additional, Strle, Franc, additional, Tsolia, Maria, additional, Vermont, Clementien L., additional, Yeung, Shunmay, additional, Zachariasse, Joany M., additional, Zenz, Werner, additional, Zavadska, Dace, additional, and Moll, Henriette A., additional

Published
2021
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27. A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children

Author

Borensztajn, Dorine M., primary, Hagedoorn, Nienke N., additional, Carrol, Enitan D., additional, von Both, Ulrich, additional, Dewez, Juan Emmanuel, additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, de Groot, Ronald, additional, Herberg, Jethro, additional, Kohlmaier, Benno, additional, Lim, Emma, additional, Maconochie, Ian K., additional, Martinon-Torres, Federico, additional, Nieboer, Daan, additional, Nijman, Ruud G., additional, Oostenbrink, Rianne, additional, Pokorn, Marko, additional, Calle, Irene Rivero, additional, Strle, Franc, additional, Tsolia, Maria, additional, Vermont, Clementien L., additional, Yeung, Shunmay, additional, Zavadska, Dace, additional, Zenz, Werner, additional, Levin, Michael, additional, and Moll, Henriette A., additional

Published
2021
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29. A clinical prediction model to identify children at risk for revisits with serious illness to the emergency department: A prospective multicentre observational study

Author

Nijman, Ruud G., primary, Borensztajn, Dorine H., additional, Zachariasse, Joany M., additional, Hajema, Carine, additional, Freitas, Paulo, additional, Greber-Platzer, Susanne, additional, Smit, Frank J., additional, Alves, Claudio F., additional, van der Lei, Johan, additional, Steyerberg, Ewout W., additional, Maconochie, Ian K., additional, and Moll, Henriette A., additional

Published
2021
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30. A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children

Author

Borensztajn, Dorine M. Hagedoorn, Nienke N. Carrol, Enitan D. and von Both, Ulrich Dewez, Juan Emmanuel Emonts, Marieke and van der Flier, Michiel de Groot, Ronald Herberg, Jethro and Kohlmaier, Benno Lim, Emma Maconochie, Ian K. and Martinon-Torres, Federico Nieboer, Daan Nijman, Ruud G. and Oostenbrink, Rianne Pokorn, Marko Rivero Calle, Irene Strle, Franc Tsolia, Maria Vermont, Clementien L. Yeung, Shunmay and Zavadska, Dace Zenz, Werner Levin, Michael Moll, Henriette A. PERFORM Consortium Personalised Ri

Abstract

Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods: The MOFICHE study prospectively collected data on febrile children (0-18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculat-ing the area under the receiver operating curve (AUC). Findings: Of 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84). The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likeli-hood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predic-tive value 0..95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90-0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use. Interpretation: Patient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow. Funding: European Union, NIHR, NHS. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Published
2021

31. Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE, a prospective observational study

Author

Hagedoorn, Nienke N. Borensztajn, Dorine Nijman, Ruud Gerard and Nieboer, Daan Herberg, Jethro Adam Balode, Anda von Both, Ulrich Carrol, Enitan Eleftheriou, Irini Emonts, Marieke and van der Flier, Michiel de Groot, Ronald Kohlmaier, Benno and Lim, Emma Maconochie, Ian Martinon-Torres, Federico Pokorn, Marko Strle, Franc Tsolia, Maria Zavadska, Dace Zenz, Werner Levin, Michael Vermont, Clementien Moll, Henriette A.

Abstract

Objectives To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers. Design Prospective observational study. Setting 12 emergency departments (EDs) in 8 European countries. Patients Febrile children aged 0-18 years. Main outcome measures IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs). Results Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%-2.0% performed poorly (ranges: sensitivity 0.59-0.93, negative LR 0.14-0.57, specificity 0.52-0.88, positive LR 1.9-4.8) and comprised 9784 patients (60%). Conclusions The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions.

Published
2021

32. Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

Author

Hagedoorn, Nienke N, primary, Zachariasse, Joany M, additional, Borensztajn, Dorine, additional, Adriaansens, Elise, additional, von Both, Ulrich, additional, Carrol, Enitan D, additional, Eleftheriou, Irini, additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, de Groot, Ronald, additional, Herberg, Jethro Adam, additional, Kohlmaier, Benno, additional, Lim, Emma, additional, Maconochie, Ian, additional, Martinón-Torres, Federico, additional, Nijman, Ruud Gerard, additional, Pokorn, Marko, additional, Rivero-Calle, Irene, additional, Tsolia, Maria, additional, Zavadska, Dace, additional, Zenz, Werner, additional, Levin, Michael, additional, Vermont, Clementien, additional, and Moll, Henriette A, additional

Published
2021
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36. Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE, a prospective observational study

Author

Hagedoorn, Nienke N, primary, Borensztajn, Dorine, additional, Nijman, Ruud Gerard, additional, Nieboer, Daan, additional, Herberg, Jethro Adam, additional, Balode, Anda, additional, von Both, Ulrich, additional, Carrol, Enitan, additional, Eleftheriou, Irini, additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, de Groot, Ronald, additional, Kohlmaier, Benno, additional, Lim, Emma, additional, Maconochie, Ian, additional, Martinón-Torres, Federico, additional, Pokorn, Marko, additional, Strle, Franc, additional, Tsolia, Maria, additional, Zavadska, Dace, additional, Zenz, Werner, additional, Levin, Michael, additional, Vermont, Clementien, additional, and Moll, Henriette A, additional

Published
2020
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37. Improving triage for children with comorbidity using the ED-PEWS: an observational study.

Author

Zachariasse, Joany M., Espina, Pinky Rose, Borensztajn, Dorine M., Nieboer, Daan, Maconochie, Ian K., Steyerberg, Ewout W., van der Lei, Johan, Greber Platzer, Susanne, and Moll, Henriette A.

Subjects
EARLY warning score, COMORBIDITY, MEDICAL triage, SCIENTIFIC observation, PERFORMANCE in children
Abstract

Objective: To assess the value of the Emergency Department-Pediatric Early Warning Score (ED-PEWS) for triage of children with comorbidity.Design: Secondary analysis of a prospective cohort.Setting and Patients: 53 829 consecutive ED visits of children <16 years in three European hospitals (Netherlands, UK and Austria) participating in the TrIAGE (Triage Improvements Across General Emergency departments) project in different periods (2012-2015).Intervention: ED-PEWS, a score consisting of age and six physiological parameters.Main Outcome Measure: A three-category reference standard as proxy for true patient urgency. We assessed discrimination and calibration of the ED-PEWS for children with comorbidity (complex and non-complex) and without comorbidity. In addition, we evaluated the value of adding the ED-PEWS to the routinely used Manchester Triage System (MTS).Results: 5053 (9%) children had underlying non-complex morbidity and 5537 (10%) had complex comorbidity. The c-statistic for identification of high-urgency patients was 0.86 (95% prediction interval 0.84-0.88) for children without comorbidity, 0.87 (0.82-0.92) for non-complex and 0.86 (0.84-0.88) for complex comorbidity. For high and intermediate urgency, the c-statistic was 0.63 (0.62-0.63), 0.63 (0.61-0.65) and 0.63 (0.55-0.73) respectively. Sensitivity was slightly higher for children with comorbidity (0.73-0.75 vs 0.70) at the cost of a lower specificity (0.86-0.87 vs 0.92). Calibration was largely similar. Adding the ED-PEWS to the MTS for children with comorbidity improved performance, except in the setting with few high-urgency patients.Conclusions: The ED-PEWS has a similar performance in children with and without comorbidity. Adding the ED-PEWS to the MTS for children with comorbidity improves triage, except in the setting with few high-urgency patients. [ABSTRACT FROM AUTHOR]

Published
2022
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38. Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study.

Author

Hagedoorn, Nienke N., Zachariasse, Joany M., Borensztajn, Dorine, Adriaansens, Elise, von Both, Ulrich, Carrol, Enitan D., Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Adam Herberg, Jethro, Kohlmaier, Benno, Lim, Emma, Maconochie, Ian, Martinón-Torres, Federico, Nijman, Ruud Gerard, Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, and Zavadska, Dace

Subjects
HOSPITAL emergency services, SYSTOLIC blood pressure, INTENSIVE care units, LONGITUDINAL method, HEART beat, DIAGNOSIS of fever, BLOOD pressure, REFERENCE values, RESEARCH, FEVER, RESEARCH methodology, SHOCK (Pathology), EVALUATION research, COMPARATIVE studies, LOGISTIC regression analysis
Abstract

Objective: (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children.Design/setting: Observational study in 11 European EDs (2017-2018).Patients: Febrile children with measured blood pressure.Main Outcome Measures: Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs).Results: Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8.Conclusions: High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED. [ABSTRACT FROM AUTHOR]

Published
2022
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39. Management of children visiting the emergency department during out-of-office hours: an observational study

Author

Schinkelshoek, Gina, primary, Borensztajn, Dorine M, additional, Zachariasse, Joany M, additional, Maconochie, Ian K, additional, Alves, Claudio F, additional, Freitas, Paulo, additional, Smit, Frank J, additional, van der Lei, Johan, additional, Steyerberg, Ewout W, additional, Greber-Platzer, Susanne, additional, and Moll, Henriëtte A, additional

Published
2020
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41. Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE, a prospective observational study.

Author

Hagedoorn, Nienke N., Borensztajn, Dorine, Nijman, Ruud Gerard, Nieboer, Daan, Herberg, Jethro Adam, Balode, Anda, von Both, Ulrich, Carrol, Enitan, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Kohlmaier, Benno, Lim, Emma, Maconochie, Ian, Martinón-Torres, Federico, Pokorn, Marko, Strle, Franc, Tsolia, Maria, and Zavadska, Dace

Subjects
URINARY tract infections, BACTERIAL meningitis, BACTERIAL diseases, PREDICTION models, LONGITUDINAL method, HOSPITAL emergency services, RESPIRATORY infections, BACTEREMIA diagnosis, DIAGNOSIS of bacterial diseases, ANTIBIOTICS, MENINGITIS diagnosis, BACTEREMIA, C-reactive protein, FEVER, INAPPROPRIATE prescribing (Medicine), MENINGITIS
Abstract

Objectives: To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers.Design: Prospective observational study.Setting: 12 emergency departments (EDs) in 8 European countries.Patients: Febrile children aged 0-18 years.Main Outcome Measures: IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs).Results: Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%-2.0% performed poorly (ranges: sensitivity 0.59-0.93, negative LR 0.14-0.57, specificity 0.52-0.88, positive LR 1.9-4.8) and comprised 9784 patients (60%).Conclusions: The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions. [ABSTRACT FROM AUTHOR]

Published
2021
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43. Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice.

Author

Sahyoun, Cyril, Cantais, Aymeric, Gervaix, Alain, Bressan, Silvia, Löllgen, Ruth, Krauss, Baruch, on behalf of the Pediatric Emergency Medicine Comfort and Analgesia Research in Europe (PemCARE) group of the Research in European Pediatric Emergency Medicine, de Jaeger, Annick, Frederiksen, Marianne Sjølin, Chéron, Gérard, Röher, Katharina, Hoffmann, Florian, Fodor, László, Sforzi, Idanna, Shavit, Itai, Pucuka, Zanda, Masilionis, Vytenis, Farrugia, Ruth, Borensztajn, Dorine, and Garrido, Ana

Subjects
HOSPITAL emergency services, PEDIATRIC emergency services, LOCAL anesthetics, PEDIATRICS, ANALGESIA, PEDIATRIC emergencies
Abstract

Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare. Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known: • Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures. • We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms "pediatrics," "hypnotics and sedatives," "conscious sedation," and "ambulatory surgical procedures" and the non-MeSH term "procedural sedation" and found no reports describing the current practice of pediatric PSA in Europe. What is New: • This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia. • Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space. [ABSTRACT FROM AUTHOR]

Published
2021
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44. Diversity in the emergency care for febrile children in Europe: a questionnaire study

Author

Borensztajn, Dorine, primary, Yeung, Shunmay, additional, Hagedoorn, Nienke N, additional, Balode, Anda, additional, von Both, Ulrich, additional, Carrol, Enitan D, additional, Dewez, Juan Emmanuel, additional, Eleftheriou, Irini, additional, Emonts, Marieke, additional, van der Flier, Michiel, additional, de Groot, Ronald, additional, Herberg, Jethro Adam, additional, Kohlmaier, Benno, additional, Lim, Emma, additional, Maconochie, Ian, additional, Martinón-Torres, Federico, additional, Nijman, Ruud, additional, Pokorn, Marko, additional, Strle, Franc, additional, Tsolia, Maria, additional, Wendelin, Gerald, additional, Zavadska, Dace, additional, Zenz, Werner, additional, Levin, Michael, additional, and Moll, Henriette A, additional

Published
2019
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47. Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study.

Author

Borensztajn, Dorine M., Hagedoorn, Nienke N., Rivero Calle, Irene, Maconochie, Ian K., von Both, Ulrich, Carrol, Enitan D., Dewez, Juan Emmanuel, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Kohlmaier, Benno, Lim, Emma, Martinon-Torres, Federico, Nieboer, Daan, Nijman, Ruud G., Pokorn, Marko, Strle, Franc, Tsolia, Maria, and Vermont, Clementien

Subjects
*RESPIRATORY infections, *HOSPITAL admission & discharge, *HOSPITAL emergency services, *CHILD patients, *MEDICAL care use
Abstract

Objectives: Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design: MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants: Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures: We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results: We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1). Conclusions: Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics. [ABSTRACT FROM AUTHOR]

Published
2021
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48. CAN DIFFERENCES IN THE FIRST ASSESSMENT AT THE ED OF CHILDREN WITH SHORTNESS OF BREATH BE EXPLAINED BY DISEASE SEVERITY ALONE?

Author

Borensztajn, Dorine

Abstract

TitleCan differences in the first assessment at the ED of children with shortness of breath be explained by disease severity alone?Background and AimsDifferences between EDu2019s in patient mix influence resource use, but other factors such as type of ED and parental demand play a role as well.Higher resource use can lead to invasive and costly healthcare, while it does not necessarily improve outcomes.Little is known about practice-pattern variation in Europe.The aim of this study was to assess differences in population characteristics and resource use in children with respiratory complaints in Europe.MethodA prospective observational study was performed, consisting of a large cohort of children visiting 5 ED's in 4 countries (UK, Austria, Portugal, the Netherlands).We included all children aged

Published
2017

49. Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational study.

Author

Hagedoorn, Nienke N., Borensztajn, Dorine M., Nijman, Ruud, Balode, Anda, von Both, Ulrich, Carrol, Enitan D., Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro, Kohlmaier, Benno, Lim, Emma, Maconochie, Ian, Martinon-Torres, Federico, Nieboer, Daan, Pokorn, Marko, Strle, Franc, Tsolia, Maria, and Yeung, Shunmay

Subjects
*RESPIRATORY infections, *URINARY tract infections, *MEDICAL prescriptions, *RESPIRATORY infections in children, *HOSPITAL emergency services
Abstract

Background: The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe.Methods and Findings: Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country.Conclusions: In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Published
2020
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50. Pulmonary interstitial Glycogenosis – a systematic analysis of new cases

Author

Seidl, Elias, primary, Carlens, Julia, additional, Reu, Simone, additional, Wetzke, Martin, additional, Ley-Zaporozhan, Julia, additional, Brasch, Frank, additional, Wesselak, Waldtraut, additional, Schams, Andrea, additional, Rauch, Daniela, additional, Schuch, Luise, additional, Kappler, Matthias, additional, Schelstraete, Petra, additional, Wolf, Monika, additional, Stehling, Floria, additional, Haarmann, Eric, additional, Borensztajn, Dorine, additional, Van De Loo, Moniek, additional, Rubak, Sune, additional, Hinrichs, Bernd, additional, Schwerk, Nicolaus, additional, and Griese, Matthias, additional

Published
2018
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