Febrile children self-referred to ER usually less severely ill

Yvette van Ierland, M.D., from MC/Sophia Children's Hospital in Rotterdam, Netherlands, and colleagues conducted an observational study of 4,609 children (aged <16 years) with fever who presented to the emergency department, as general practitioner (GP)-referred or self-referred patients. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up.

The researchers found that 38 percent of the febrile children were referred by their GP and 62 percent were self-referred. Forty-six percent of GP-referred children were classified as high urgency (immediate/very urgent categories) cases, compared with 45 percent of self-referrals. Forty-three percent of GP referrals and 27 percent of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio, 2.0). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.

"Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child's illness," the authors write.

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