Alarming Signs of Serious Infections in Febrile Children

181 Pages·2013·11.6 MB·English

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Alarming Signs of Serious Infections in Febrile Children:
Studies in Primary Care and Hospital Emergency Care
Yvette van Ierland
COLOFON
The studies described in this thesis were financially supported by:
Chapter 2: The Ministry of Health, Welfare and Sport (VWS), The Netherlands and the Dutch
Organisation for Scientific Research (ZonMw).
Chapters 3 to 8: An unrestricted grant from the Europe Container Terminals B.V. Rotterdam, The
Netherlands.
Publication of this thesis was financially supported by the Erasmus University Rotterdam,
the Sophia Children’s Hospital - Erasmus University Medical Center, Department of General
Paediatrics, Rotterdam, and the HAGA Hospital, The Hague, The Netherlands.
Cover: “The icons of my PhD-project” by Yvette van Ierland.
Lay-out and printing: Gildeprint, Enschede, The Netherlands.
ISBN: 978-94-6108-531-3
© Yvette van Ierland, 2013
All rights reserved. No part of the material protected by this copyright notice may be reproduced
or utilized in any form or by any electronic, mechanical, or other means, now known, hereafter
invented, including photocopying and recoding, or in any information storage and retrieval
system without prior written permission of the author.
Alarming Signs of Serious Infections in Febrile Children:
Studies in Primary Care and Hospital Emergency Care
Alarmsymptomen van ernstige infecties bij kinderen met koorts:
Studies binnen de spoedzorgketen
Proefschrift
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam
op gezag van de
rector magnificus
Prof.dr. H.A.P. Pols
en volgens besluit van het College voor Promoties.
De openbare verdediging zal plaatsvinden op
woensdag 4 december 2013 om 15:30 uur
door
Yvette van Ierland
geboren te Utrecht
PROMOTIECOMMISSIE
Promotor: Prof.dr. H.A. Moll

Overige leden: Prof.dr. J. van der Lei
Prof.dr. M.Y. Berger
Prof.dr. A.J. van der Heijden
Co-promotor: Dr. R. Oostenbrink
TABLE OF CONTENTS
CHAPTER 1 General introduction, aims and outline 7
PART I CHARACTERISTICS OF PAEDIATRIC EMERGENCY CARE POPULATIONS
CHAPTER 2 Validity of telephone and physical triage in emergency care: 21
the Netherlands Triage System

CHAPTER 3 Self-referral and serious illness in children with fever 37
PART II ALARMING SIGNS OF SERIOUS INFECTIONS IN FEBRILE CHILDREN
CHAPTER 4 Alarming signs and symptoms in febrile children in primary 57
care: an observational cohort study
CHAPTER 5 Alarming signs and antibiotic prescription in febrile children in 69
primary care: an observational cohort study
CHAPTER 6 The role of alarming signs in referral management of febrile children 85
consulting primary out-of-hours care
CHAPTER 7 Alarming signs in the Manchester Triage System: a tool to 101
identify febrile children at risk of hospitalization
PART III CLINICAL PREDICTION RULES FOR SERIOUS INFECTIONS IN PRIMARY
OUT-OF-HOURS CARE
CHAPTER 8 The diagnostic value of clinical prediction rules for febrile 119
children in primary out-of-hours care: an observational cohort
study

CHAPTER 9 General discussion and future research perspectives 139
CHAPTER 10 English summary/Nederlandse samenvatting 153
APPENDICES
I List of abbreviations 167
II Authors and affiliations 168
III List of publications 170
IV About the author 171
V PhD Portfolio 172
VI Dankwoord 175
1
CHAPTER

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