To prescribe or not to prescribe for paediatric sore throat: a retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary paediatric emergency department and a national review of practice

2021 ◽  
pp. emermed-2020-210786
Author(s):  
Michael Malley ◽  
Katie Driver ◽  
Megan Costelloe ◽  
Isla Monaghan ◽  
Lucy Jefferson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sore Throat ◽  
Retrospective Cohort Study ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Antibiotic Prescription ◽  
Scoring Systems ◽  
Prescription Rates ◽  
National Practice ◽  
Clinician Practice

BackgroundTonsillopharyngitis is a common presentation to paediatric emergency departments (PEDs). FeverPAIN (FP) and Centor scoring systems are recommended in the UK to help delineate bacterial aetiology, despite being primarily evidenced in adult populations. We investigate how the use of FP or Centor compares to actual clinician practice in guiding antibiotic prescription rates in PED. We establish current national practice in English PEDs.MethodsWe performed a retrospective cohort study of tonsillopharyngitis presentations to a tertiary PED in January–February 2020. Investigators retrospectively assigned each patient FP and Centor scores using documented symptoms. We compared antibiotic prescription rates guided by FP/Centor against the actual rate prescribed by clinicians, and assessed agreement between these strategies using kappa analysis. We contacted 153 English emergency departments to establish national practice.ResultsWe identified 632 consecutive patients aged 6 months to 15 years. Actual clinician-prescribed antibiotics numbered 116 (18.4%). Prescriptions predicted by FP score numbered 124 (19.6%) and Centor 112 (17.7%). Kappa (K) analysis indicated only moderate agreement between clinician choice versus FP (K=0.434) and clinician choice versus Centor (K=0.476). This was similar for cohorts aged under and over 3 years.National practice was reportedly heterogeneous, with 70 emergency departments (45.8%) not employing a specific system.ConclusionCurrent guidance is variably interpreted and inconsistently implemented in paediatric populations. FeverPAIN and Centor scoring systems may not rationalise antibiotics as much as previously reported compared with judicious clinician practice. Producing clear paediatric-specific national guidelines, especially for under-5s who are omitted from NICE sore throat guidance, may help further rationalise and standardise antibiotic use in paediatric tonsillopharyngitis.

scholarly journals Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study

2017 ◽  
Vol 67 (657) ◽  
pp. e300-e305 ◽  
Author(s):  
Lavanya Diwakar ◽  
Carole Cummins ◽  
Ronan Ryan ◽  
Tom Marshall ◽  
Tracy Roberts
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Number Of Children ◽  
Prescription Rates ◽  
The Uk ◽  
Primary Care Practices

BackgroundAdrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.Aim To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.Design and setting Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.MethodChildren and young people aged between 0–17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).ResultsA total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.ConclusionThe number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.

scholarly journals Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christophe L. Bertin ◽  
Simon Ponthus ◽  
Hari Vivekanantham ◽  
Pierre-Alexandre Poletti ◽  
Omar Kherad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Abdominal Radiography ◽  
Plain Abdominal Radiography

scholarly journals Return visits to the pediatric emergency department: A multicentre retrospective cohort study

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 578-585 ◽  
Author(s):  
Colin B. Meyer-Macaulay ◽  
Mimi Truong ◽  
Garth D. Meckler ◽  
Quynh H. Doan
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Significant Proportion ◽  
Pediatric Emergency ◽  
Index Visit ◽  
Return Visits

AbstractObjectiveReturn visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED.MethodsWe conducted a retrospective cohort study of all visits to a referral centre PED between August 2012 and August 2013. We compared demographic variables between children with and without an RTED, measures of flow and disposition outcomes between the initial (index) visit and RTED, and between RTED to the original PED versus to other EDs in the community.ResultsAmong all PED visits, 7.6% had an RTED within 7 days, of which 13% were to a facility other than the original PED. Children with an RTED had higher acuity and longer length of stay on their index visit. They were also more likely to be admitted on a subsequent visit than the overall PED population. RTED to the original PED had a longer waiting time (WT), length of stay, and more frequently resulted in hospitalization than RTED to a general ED.ConclusionsA significant proportion of RTED occur at a site other than where the original ED visit occurred. Examining RTED to and from only PEDs underestimates its burden on emergency health services.

scholarly journals Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

2019 ◽  
Author(s):  
Leonard Mermel ◽  
Sarah L. Weatherall ◽  
Alison B. Chambers
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia.Methods Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables.Results 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4°F) at triage. Triage temperatures were 100.5°F (95% CI 99.9-101.2°F) and 99.0°F (95% CI 98.4-99.6°F) in the hemodialysis and non-hemodialysis cohorts, respectively (p<0.001). Triage temperature in patients with and without diabetes mellitus was 99.2°F (95% CI 98.4-99.9°F) and 100.4°F (95% CI 99.7-101.0°F), respectively (p=0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19).Conclusions Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

scholarly journals Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

2019 ◽  
Vol 69 (4) ◽  
pp. 273-280 ◽  
Author(s):  
Ruza Bjelovucic ◽  
Matej Par ◽  
Diana Rubcic ◽  
Danijela Marovic ◽  
Katica Prskalo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antibiotic Prescription ◽  
Dental Service
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