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Background: Deprivation generates many health inequalities. This has to be taken in account to enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health. Methods: The French Individual Child Deprivation Index (FrenChILD-Index) was designed in four phases: item generation then reduction using the literature review and expert opinions, and index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, concordance with a blinded evaluation by an expert enabled us to determine thresholds for two levels of moderate and severe deprivation. Results: The generation and reduction phases retained 13 items. These were administered to 986 children for the derivation and validation phases. In the validation phase, the final 12 items of the FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children) a sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care), the sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9]. Conclusions: The FrenChILD-Index is the first pediatric individual-level index of deprivation validated in Europe. It enables clinical practice to address the social determinants of health and meet public health goals.

International audience; Introduction: Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED).Methods: Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority.Results: A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France.Discussion: Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.

The purpose of this study was to develop and validate a pediatric individual-level index for deprivation, usable in clinical practice and in public health. The index had a 4 phases development: items generation with literature review and experts interviews, items reduction with steering committee consensus, index derivation with multivariate analysis, and index validation with psychometric and Pearson analysis. French Child Individual-Level Deprivation Index (FrenChILD-Index) was addressed by untrained healthcare professionals in a cross-sectional multicentric study. The deprivation burden was blindly evaluated in every domain of lifestyle by an expert. Children in need of one specific type of healthcare for deprived children were: moderately deprived. Children in need of referral to a socio-medical unit for access to healthcare were: severely deprived. The main outcome measure was the agreement between FrenChILD-Index results and expert evaluation.Development phases produced a 12-item instrument. Validation phases were carried out in a 986 children sample. FrenChILD-Index fulfilled the Terwee validity criterion for screening instruments. For moderate deprivation, sensitivity was 96.0% [92.6; 98.7] and specificity 68.3% [65.2; 71.4]. For severe deprivation, sensitivity was 96.3% [92.7; 100] and specificity 91.1% [89.2; 92.9]. It correlated with the number of lifestyle deprived domains 0.80 [0.77; 0.83] and the amount of specific healthcare for children 0.86 [0.83; 0.88].Conclusions: FrenChILD-Index is the first pediatric individual-level index of deprivation, methodologically validated in Europe. FrenChILD-Index enables individual appropriate referral for deprived children. It enables considering social determinants of health into account in epidemiological adjustment, patient sample stratification and program impact measurement. (NCT03640715, 21/08/2018)

Importance The procalcitonin (PCT) assay is an accurate screening test for identifying invasive bacterial infection (IBI); however, data on the PCT assay in very young infants are insufficient. Objective To assess the diagnostic characteristics of the PCT assay for detecting serious bacterial infection (SBI) and IBI in febrile infants aged 7 to 91 days. Design, Setting, and Participants A prospective cohort study that included infants aged 7 to 91 days admitted for fever to 15 French pediatric emergency departments was conducted for a period of 30 months (October 1, 2008, through March 31, 2011). The data management and analysis were performed from October 1, 2011, through October 31, 2014. Main Outcomes and Measures The diagnostic characteristics of the PCT assay, C-reactive protein (CRP) concentration, white blood cell (WBC) count, and absolute neutrophil cell (ANC) count for detecting SBI and IBI were described and compared for the overall population and subgroups of infants according to the age and the duration of fever. Laboratory test cutoff values were calculated based on receiver operating characteristic (ROC) curve analysis. The SBIs were defined as a pathogenic bacteria in positive culture of blood, cerebrospinal fluid, urine, or stool samples, including bacteremia and bacterial meningitis classified as IBIs. Results Among the 2047 infants included, 139 (6.8%) were diagnosed as having an SBI and 21 (1.0%) as having an IBI (11.0% and 1.7% of those with blood culture (n = 1258), respectively). The PCT assay offered an area under the curve (AUC) of ROC curve similar to that for CRP concentration for the detection of SBI (AUC, 0.81; 95% CI, 0.75-0.86; vs AUC, 0.80; 95% CI, 0.75-0.85; P = .70). The AUC ROC curve for the detection of IBI for the PCT assay was significantly higher than that for the CRP concentration (AUC, 0.91; 95% CI, 0.83-0.99; vs AUC, 0.77; 95% CI, 0.65-0.89; P = .002). Using a cutoff value of 0.3 ng/mL for PCT and 20 mg/L for CRP, negative likelihood ratios were 0.3 (95% CI, 0.2-0.5) for identifying SBI and 0.1 (95% CI, 0.03-0.4) and 0.3 (95% CI, 0.2-0.7) for identifying IBI, respectively. Similar results were obtained for the subgroup of infants younger than 1 month and for those with fever lasting less than 6 hours. Conclusions and Relevance The PCT assay has better diagnostic accuracy than CRP measurement for detecting IBI; the 2 tests perform similarly for identifying SBI in febrile infants aged 7 to 91 days.

Importance Acute bronchiolitis is the leading cause of hospitalization among infants. Previous studies, underpowered to examine hospital admission, have found a limited benefit of nebulized hypertonic saline (HS) treatment in the pediatric emergency department (ED). Objective To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis. Design, Setting, and Participants The Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) study was a multicenter, double-blind randomized clinical trial on 2 parallel groups conducted during 2 bronchiolitis seasons (October through March) from October 15, 2012, through April 15, 2014, at 24 French pediatric EDs. Among the 2445 infants (6 weeks to 12 months of age) assessed for inclusion, 777 with a first episode of acute bronchiolitis with respiratory distress and no chronic medical condition were included. Interventions Two 20-minute nebulization treatments of 4 mL of HS, 3%, or 4 mL of normal saline (NS), 0.9%, given 20 minutes apart. Main Outcomes and Measures Hospital admission rate in the 24 hours after enrollment. Results Of the 777 infants included in the study (median age, 3 months; interquartile range, 2-5 months; 468 [60.2%] male), 385 (49.5%) were randomized to the HS group and 387 (49.8%) to the NS group (5 patients did not receive treatment). By 24 hours, 185 of 385 infants (48.1%) in the HS group were admitted compared with 202 of 387 infants (52.2%) in the NS group. The risk difference for hospitalizations was not significant according to the mixed-effects regression model (adjusted risk difference, –3.2%; 95% CI, –8.7% to 2.2%; P = .25). The mean (SD) Respiratory Distress Assessment Instrument score improvement was greater in the HS group (–3.1 [3.2]) than in the NS group (–2.4 [3.3]) (adjusted difference, –0.7; 95% CI, –1.2 to –0.2; P = .006) and similarly for the Respiratory Assessment Change Score. Mild adverse events, such as worsening of cough, occurred more frequently among children in the HS group (35 of 392 [8.9%]) than among those in the NS group (15 of 384 [3.9%]) (risk difference, 5.0%; 95% CI, 1.6%-8.4%; P = .005), with no serious adverse events. Conclusions and Relevance Nebulized HS treatment did not significantly reduce the rate of hospital admissions among infants with a first episode of acute moderate to severe bronchiolitis who were admitted to the pediatric ED relative to NS, but mild adverse events were more frequent in the HS group. Trial Registration clinicaltrials.gov Identifier:NCT01777347

Objectif decrire les modalites de prise en charge du nourrisson febrile ≤3 mois et les comparer aux recommandations. Methodes une etude prospective multicentrique incluant des nourrissons ≤3 mois febriles sans point d’appel s’est deroulee dans 15 centres d’urgences pediatriques. La frequence des examens complementaires realises, des antibiotiques prescrits et des hospitalisations etait comparee entre les centres. Les variations par rapport aux recommandations etaient decrites selon differents scenarii et comparees entre les centres. Resultats Parmi les 2204 enfants inclus, les frequences d’examens realises : hemoculture (62%), culture urinaire (68%), ponction lombaire (64%), recherche virale naso-pharyngee (33%) et radiographie de thorax (67%), de prescription d’antibiotiques (42%), et d’hospitalisations (74%) etaient toutes significativement differents entre les centres, meme apres ajustement sur l’âge, l’apparence clinique et la duree de la fievre. Le taux d’adequation aux recommandations etait evalue entre 60 et 80% selon les scenarii de prise en charge, et variait significativement entre les centres. Conclusion la prise en charge du nourrisson febrile ≤ 3 mois varie entre differents centres et par rapport aux recommandations.

Objectif evaluer les performances de la procalcitonine (PCT) pour identifier les infections bacteriennes severes (IBS) et invasives (IBI) chez le nourrisson ≤ 3 mois febrile Methodes une etude prospective multicentrique incluant des enfants febriles sans point d’appel et âges de 7 a 92 jours s’est deroulee dans 15 centres d’urgences pediatriques. Un diagnostic final (IBS, IBI ou absence d’infection bacterienne) etait etabli. La procalcitonine prelevee a l’admission etait dosee quantitativement Resultats la PCT et C-reactive proteine (CRP) etaient connues pour 2047 enfants. Vingt et un (1%) avaient une IBI (13 bacteriemies et 8 meningites) et 124 (6%) une IBS. L’aire sous la courbe (AUC) pour la PCT et la CRP etaient de 0.76 (IC 95% 0.71-0.80) et 0.78 (IC 95% 0.74-0.82) parmi les IBS, respectivement (p=0.3). Parmi les IBI, l’AUC de la PCT (0.92, IC 95% 0.85-0.99) etait plus elevee que celle de la CRP (0.80, IC 95% 0.69-0.91) (p=0.004). Le seuil optimal de la PCT etait calcule a 0.3 ng/mL. Le rapport de vraisemblance negatif, parmi les IBI, etait 0.11 (IC 95% 0.03–0.44) pour la PCT Conclusion les performances de la PCT sont similaires a celles de la CRP pour la detection d’IBS, mais meilleures pour la detection d’IBI