Article Text

Download PDFPDF

Original research
Diversity in the emergency care for febrile children in Europe: a questionnaire study
  1. Dorine Borensztajn1,
  2. Shunmay Yeung2,
  3. Nienke N Hagedoorn1,
  4. Anda Balode3,
  5. Ulrich von Both4,5,
  6. Enitan D Carrol6,7,
  7. Juan Emmanuel Dewez2,
  8. Irini Eleftheriou8,
  9. Marieke Emonts9,10,
  10. Michiel van der Flier11,12,
  11. Ronald de Groot11,
  12. Jethro Adam Herberg13,14,
  13. Benno Kohlmaier15,
  14. Emma Lim9,
  15. Ian Maconochie13,14,
  16. Federico Martinón-Torres16,
  17. Ruud Nijman13,14,
  18. Marko Pokorn17,
  19. Franc Strle17,
  20. Maria Tsolia8,
  21. Gerald Wendelin15,
  22. Dace Zavadska3,
  23. Werner Zenz15,
  24. Michael Levin13,14,
  25. Henriette A Moll1
  1. 1 Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2 Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
  3. 3 Department of Pediatrics, Rīgas Stradiņa Universitāte, Children's Clinical University Hospital, Riga, Latvia
  4. 4 Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
  5. 5 German Centre for Infection Research DZIF, Munich, Germany
  6. 6 Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  7. 7 Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  8. 8 Second Department of Paediatrics, P & A Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
  9. 9 Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children’s Hospital, Newcastle upon Tyne, UK
  10. 10 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  11. 11 Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
  12. 12 Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
  13. 13 Section of Paediatrics, Imperial College, London, UK
  14. 14 Paediatric Emergency Department, Imperial College Healthcare NHS Trust, London, UK
  15. 15 Department of General Paediatrics, Medical University of Graz, Graz, Austria
  16. 16 Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  17. 17 Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
  1. Correspondence to Dr Dorine Borensztajn; d.borensztajn{at}


Objective To provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children.

Design and setting An electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK.

Outcome measures The questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates).

Results Reported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries.

Conclusion Differences in local, regional and national aspects of care exist in the management of febrile children across Europe. This variability has to be considered when trying to interpret differences in the use of diagnostic tools, antibiotics and admission rates. Any future implementation of interventions or diagnostic tests will need to be aware of this European diversity.

  • infectious diseases
  • accident & emergency

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors Conceptualisation: DB, SY, IM, FM-T, JAH, EDC, ME, MT, RdG, MvdF, WZ, FS, MP, DZ, UvB, ML, HAM. Funding: SY, IM, FM-T, JAH, EDC, ME, MT, RdG, MvdF, WZ, FS, MP, DZ, UvB, ML, HAM. Data curation: DB, NNH, SY, IM, FM-T, JAH, EDC, ME, MT, RdG, MvdF, WZ, FS, MP, DZ, UvB, ML, HAM, RN, JED, EL, IE, BK, GW, AB. Formal analysis: DB, HAM. Investigation: DB, NNH, SY, IM, FM-T, JAH, EDC, ME, MT, RdG, MvdF, WZ, FS, MP, DZ, UvB, ML, HAM, RN, JED, EL, IE, BK, GW, AB. Project administration: HAM. Supervision: HAM. Writing—original draft: DB. Writing—review and editing: DB, NNH, SY, JED, IM, FM-T, JAH, EDC, ME, MT, RdG, MvdF, WZ, BK, FS, MP, DZ, UvB, ML and HAM.

  • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no 668303. The research was supported by the National Institute for Health Research Biomedical Research Centre based at Imperial College (JAH, ML) and at Newcastle Hospitals NHS Foundation Trust and Newcastle University (EL, ME). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.