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Abstract：
Evaluation of guidelines in actual practice is a crucial step in guideline improvement. A retrospective evaluation of the Dutch guideline for children with fever without an apparent source (FWS) showed 50% adherence in young infants. We prospectively evaluated adherence to the Dutch guideline and its impact on management in current practice. Prospective observational multicenter cross-sectional study, including children 3 days to 16 years old presented for FWS at one of seven emergency departments in participating secondary and tertiary care hospitals in the Netherlands. Adherence to the Dutch FWS guideline, adapted from the National Institute for Health and Care Excellence (NICE) guideline, was evaluated, and patterns in non-adherence and the impact of non-adherence on clinical outcomes and resource use were explored. Adherence to the guideline was 192/370 (52%). Adherence was lowest in patients categorized as high risk for severe infection (72/187, 39%), compared to the low-risk group (64/73, 88%). Differences in adherence were significant between risk categories (P < 0.001) but not between age categories. In case of non-adherence, less urinalysis, fewer bacterial cultures (blood, urine, and cerebral spinal fluid), and less empirical antibiotic treatment were performed (P < 0.050). Clinical outcomes were not significantly different between the non-adherence and the adherence group, particularly regarding missed severe infections.
CONCLUSIONS: We found a high non-adherence rate of 48%, which did not lead to unfavorable clinical outcomes. This substantiates the need for a critical reevaluation of the FWS guideline and its indications for bacterial cultures, viral testing, and antibiotic treatment.
BACKGROUND: • Despite the development of national guidelines, variation in practice is still substantial in the assessment of febrile children to distinguish severe infection from mild self-limiting disease. • Previous retrospective research suggests low adherence to national guidelines for febrile children in practice.
BACKGROUND: • In case of non-adherence to the Dutch national guideline, similar to the National Institute for Health and Care Excellence (NICE) guideline from the United Kingdom, physicians have used fewer resources than the guideline recommended without increasing missed severe infections.
CONCLUSIONS: We found a high non-adherence rate of 48%, which did not lead to unfavorable clinical outcomes. This substantiates the need for a critical reevaluation of the FWS guideline and its indications for bacterial cultures, viral testing, and antibiotic treatment.
BACKGROUND: • Despite the development of national guidelines, variation in practice is still substantial in the assessment of febrile children to distinguish severe infection from mild self-limiting disease. • Previous retrospective research suggests low adherence to national guidelines for febrile children in practice.
BACKGROUND: • In case of non-adherence to the Dutch national guideline, similar to the National Institute for Health and Care Excellence (NICE) guideline from the United Kingdom, physicians have used fewer resources than the guideline recommended without increasing missed severe infections.
摘要：
在实际实践中对指南进行评估是指南改进的关键步骤。对荷兰指南对无明显来源的发烧儿童（FWS）的回顾性评估显示，年轻婴儿的依从性为50％。我们前瞻性地评估了对荷兰指南的遵守情况及其在当前实践中对管理的影响。前瞻性观察多中心横断面研究，包括在荷兰参与的二级和三级护理医院的七个急诊科之一为FWS提供的3天至16岁的儿童。遵守荷兰FWS准则，改编自国家健康与护理卓越研究所(NICE)指南，被评估,并探讨了非依从性的模式以及非依从性对临床结局和资源使用的影响.遵守该指南为192/370（52％）。严重感染高危患者的依从性最低（72/187，39%），与低风险组相比（64/73，88%）。风险类别之间的依从性差异显着（P<0.001），但年龄类别之间没有差异。如果不遵守，尿液分析较少，更少的细菌培养物(血液，尿液,和脑脊液)，经验性抗生素治疗较少（P<0.050）。不依从组和依从组之间的临床结果没有显着差异。特别是关于严重感染的遗漏。
结论：我们发现48％的不依从率很高，这并没有导致不利的临床结果。这证实了对FWS指南及其细菌培养适应症进行严格重新评估的必要性。病毒测试,和抗生素治疗。
背景：•尽管制定了国家指南，在评估发热儿童以区分严重感染和轻度自限性疾病方面，实践中的差异仍然很大。•以前的回顾性研究表明，在实践中对发热儿童国家指南的依从性较低。
背景：•如果不遵守荷兰国家准则，类似于英国国家健康与护理卓越研究所（NICE）指南，与指南建议相比,医师使用的资源较少,但未发生严重感染.
结论：我们发现48％的不依从率很高，这并没有导致不利的临床结果。这证实了对FWS指南及其细菌培养适应症进行严格重新评估的必要性。病毒测试,和抗生素治疗。
背景：•尽管制定了国家指南，在评估发热儿童以区分严重感染和轻度自限性疾病方面，实践中的差异仍然很大。•以前的回顾性研究表明，在实践中对发热儿童国家指南的依从性较低。
背景：•如果不遵守荷兰国家准则，类似于英国国家健康与护理卓越研究所（NICE）指南，与指南建议相比,医师使用的资源较少,但未发生严重感染.
