Rianne Oostenbrink - Academia.edu (original) (raw)
Papers by Rianne Oostenbrink
BMJ Paediatrics Open, Sep 1, 2019
To cite: van Houten C, van de Maat JS, Naaktgeboren C, et al. Update of a clinical prediction mod... more To cite: van Houten C, van de Maat JS, Naaktgeboren C, et al. Update of a clinical prediction model for serious bacterial infections in preschool children by adding a host-protein-based assay: a diagnostic study.
BMJ Paediatrics Open
ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their he... more ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.DesignThis cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January–May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres.ResultsOverall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units...
BackgroundTo investigate the impact of the COVID-19 pandemic and infection prevention measures on... more BackgroundTo investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe.MethodsRoutine health data were extracted retrospectively from electronic patient records of children aged <16 years, presenting to 38 emergency departments (ED) in 16 European countries for the period January 2018 – May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRR) were used to compare age groups, diagnoses and outcomes.FindingsReductions in pediatric ED attendances, hospital admissions and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (incidence rate ratio (IRR) 2·62, 95% CI 2·19 to 3·13) and in children aged >12 months (12-<24 months IRR 0·89, 95% CI 0·86 to 0·92; 2-...
European Journal of Pediatrics, 2021
The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic pre... more The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016–2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9–30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48–21.2]). Abnormalities on CXR were not signi...
Journal of Antimicrobial Chemotherapy, 2021
Background Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in chil... more Background Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands. Objectives Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries. Methods We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying eff...
Nederlands Tijdschrift voor Geneeskunde, 2015
Koorts is bij kinderen een van de meest voorkomende symptomen op de SEH. 1,2 Dit is de reden van ... more Koorts is bij kinderen een van de meest voorkomende symptomen op de SEH. 1,2 Dit is de reden van 10-20% van alle ziekenhuisopnames. 3,4 Koorts kan verschillende oorzaken hebben, die variëren van relatief onschuldige virale infecties tot ernstige bacteriële infecties (EBI's), zoals sepsis, pneumonie of urineweginfectie. Voor een arts is het van belang het kind met een EBI te herkennen te midden van de grote groep kinderen met koorts; dit is een diagnostische uitdaging. 5,6 Ter ondersteuning van artsen zijn er diverse richtlijnen en beslismodellen ontwikkeld die het risico op ernstige infecties inschatten, met als doel het verbeteren van het diagnostische traject en van de kosteneffectiviteit. 7-9 Beslismodellen geven echter vaak alleen risicoschattingen zonder adviezen over de behandeling en aanvullende diagnostiek. Bovendien ontbreken regelmatig implementatiestudies, waardoor het onduidelijk is of het gebruik van deze hulpmiddelen het handelen van de arts in de dagelijkse praktijk ook daadwerkelijk beïnvloedt. 10,11 In deze studie onderzochten we de bruikbaarheid van een klinische beslisregel voor kinderen met koorts en het effect (de impact) van toepassing van dit beslismodel op Doel Onderzoeken hoe bruikbaar een klinisch beslismodel is voor het voorspellen van het risico op ernstige bacteriële infecties (EBI's) bij kinderen met koorts op de SEH, en wat het effect is van toepassing van dit beslismodel op de dagelijkse praktijk. opzet Gerandomiseerde gecontroleerde studie. MethoDe We includeerden 439 kinderen met koorts in de leeftijd van 1 maand-15 jaar op de SEH van het Erasmus MC-Sophia Kinderziekenhuis in de periode 2010-2012. De kinderen werden willekeurig toegewezen aan de interventie-(beslismodel; n = 219) of controlegroep (routinezorg; n = 220). Het beslismodel omvat klinische kenmerken en een CRPbepaling, en genereert een risicoschatting voor de diagnoses 'pneumonie' en 'overige EBI's'. Bij hoog-risicokinderen initieerden verpleegkundigen aanvullend onderzoek op advies van het beslismodel. De primaire uitkomstmaat was het aantal correcte EBI-diagnoses. Secundaire uitkomstmaten omvatten verblijfsduur op de SEH, diagnostiek, behandeling, follow-up en medische kosten (Nederlands Trial Register: NTR2381). Resultaten Het beslismodel discrimineerde goed tussen pneumonie (n = 33; 'area under the receiver operating characteristic curve' (AUC): 0,83; 95%-BI: 0,75-0,90) en overige EBI's (n = 22; AUC: 0,81; 95%-BI: 0,72-0,90). 86% van de adviezen werden nagekomen. Er was geen verschil in het aantal correcte EBI-diagnoses tussen beide groepen. Toepassing van het beslismodel resulteerde in een afname van het aantal bloedbeeldaanvragen (14 vs. 22%; p < 0,05) en meer urine-'dipstick'-testen (71 vs. 61%; p < 0,05). ConClusie Het gebruik van een klinisch beslismodel op een universitaire kindergeneeskundige SEH heeft geen invloed op het stellen van de correcte EBI-diagnose, maar leidt wel tot een meer gestandaardiseerde benadering van het kind met koorts. *Dit onderzoek werd eerder gepubliceerd in PLOS ONE (2015;10:e0127620) met als titel 'Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial'. Afgedrukt met toestemming.
Genetics in Medicine, 2021
Purpose By incorporating major developments in genetics, ophthalmology, dermatology, and neuroima... more Purpose By incorporating major developments in genetics, ophthalmology, dermatology, and neuroimaging, to revise the diagnostic criteria for neurofibromatosis type 1 (NF1) and to establish diagnostic criteria for Legius syndrome (LGSS). Methods We used a multistep process, beginning with a Delphi method involving global experts and subsequently involving non-NF experts, patients, and foundations/patient advocacy groups. Results We reached consensus on the minimal clinical and genetic criteria for diagnosing and differentiating NF1 and LGSS, which have phenotypic overlap in young patients with pigmentary findings. Criteria for the mosaic forms of these conditions are also recommended. Conclusion The revised criteria for NF1 incorporate new clinical features and genetic testing, whereas the criteria for LGSS were created to differentiate the two conditions. It is likely that continued refinement of these new criteria will be necessary as investigators (1) study the diagnostic properti...
Emergency Medicine Australasia, 2021
ObjectivesThe Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent fo... more ObjectivesThe Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in paediatric emergency care to organise globally for the conduct of collaborative research across networks.MethodsPERN has grown from five to eight member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children.ResultsBeginning as a pandemic response studying H1N1 influenza risk factors in children, PERN research has progres...
The Lancet Regional Health - Europe, 2021
Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quali... more Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods: The MOFICHE study prospectively collected data on febrile children (0À18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included
The Lancet Infectious Diseases, 2021
European Journal of Pediatrics, 2017
With great interest, we read the paper of Falszewska et al. [1] on the diagnostic accuracy of cli... more With great interest, we read the paper of Falszewska et al. [1] on the diagnostic accuracy of clinical dehydration scales in children. They observed limited diagnostic value of the clinical dehydration scale (CDS) [2] only in ruling-in severe weight-change-based dehydration, whereas the WHO [3] and the Gorelick scale [4] showed no association. Pre-and post-illness weight change is considered the gold standard in the assessment of dehydration in children with acute gastroenteritis (AGE). However, pre-illness weight rarely is available at presentation. Similar to Falszewska, we used weight change as a reference standard of dehydration during our randomized controlled trial (NTR number 2304) on ambulant rehydration in children aged 1 month-5 years with AGE visiting the emergency department
European Journal of Human Genetics, 2020
PTEN hamartoma tumour syndrome is a diverse multi-system disorder predisposing to the development... more PTEN hamartoma tumour syndrome is a diverse multi-system disorder predisposing to the development of hamartomatous growths, increasing risk of breast, thyroid, renal cancer, and possibly increasing risk of endometrial cancer, colorectal cancer and melanoma. There is no international consensus on cancer surveillance in PHTS and all current guidelines are based on expert opinion. A comprehensive literature review was undertaken and guidelines were developed by clinicians with expertise from clinical genetics, gynaecology, endocrinology, dermatology, radiology, gastroenterology and general surgery, together with affected individuals and their representatives. Recommendations were put forward for surveillance for breast, thyroid and renal cancers. Limited recommendations were developed for other sites including endometrial, colon and skin. The proposed cancer surveillance recommendations for PHTS require a coordinated multidisciplinary approach and significant patient commitment. The ev...
The Lancet Infectious Diseases, 2019
Background Prevalence of serious bacterial infections in children in countries in western Europe ... more Background Prevalence of serious bacterial infections in children in countries in western Europe and the USA is low. Antibiotic stewardship aims at a more rational use of antibiotics but information on the frequency of antibiotic prescription to children in emergency departments is scarce. We aimed to quantify and explain variability in antibiotic prescription in children attending European paediatric emergency departments. Methods We did a cross-sectional, observational study of children aged between 1 month and 16 years who presented with fever to one of 28 European emergency departments on one random sampling day per month between Nov 1, 2014, and Feb 28, 2016. The surveyed sites were spread across 11 countries and included 17 academic hospitals with 3000 to up to 80 000 annual visits to their paediatric emergency departments. We determined the proportion of children without comorbidities who received antibiotic prescriptions by country, focus of infection, and type of antibiotic. We then did a detailed analysis of the same population, using a multilevel logistic regression analysis, into the variability in prescriptions across hospitals, focusing particularly on respiratory tract infections and correcting for a combination of result-dependent factors. Random group assignment was done by computer randomisation. Findings Of 5177 children in total, 617 children had comorbidities. Of the 4560 children without comorbidities, 1454 (32%) received antibiotics. This percentage varied from 19% to 64% across countries. Of these 1454 prescriptions issued, 893 (61%) were second-line antibiotics. Antibiotic prescription for respiratory tract infections, the most common infection type, in children without comorbidities was most variable across countries (15-67% for upper respiratory tract infections and 24-87% for lower respiratory tract infections) and was associated with age (odds ratio [OR] 1•51, 95% CI 1•08-2•13), fever duration (OR 1•45, 1•01-2•07), blood concentrations of C-reactive protein (OR 2•31, 1•67-3•19), and chest x-ray results (OR 10•62, 5•65-19•94, for focal abnormalities; OR 3•49, 1•59-7•64, for diffuse abnormalities). After correcting for patient characteristics, diagnostic assessment, and hospital characteristics, antibiotic prescription for respiratory tract infections remained highly variable across emergency departments (standardised antibiotic prescription ratio 0•49-2•04). Interpretation Antibiotic prescription in European emergency departments is highly variable, with frequent use of second-line antibiotics. To ensure successful antibiotic stewardship initiatives in Europe aimed at reducing unnecessary prescription of antibiotics, variability of prescription across hospitals should be considered, drivers of suboptimal antibiotic prescription at the local level need to be identified, and European guidelines need to be devised.
Journal of Autism and Developmental Disorders, 2018
In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of a... more In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)-and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational-and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.
Archives of Disease in Childhood, 2012
Archives of Disease in Childhood, 2017
Objective To assess the diagnostic value and determinants of nurses’ clinical impression for the ... more Objective To assess the diagnostic value and determinants of nurses’ clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). Design Secondary analysis of a prospective cohort. Setting and patients 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. Main outcome measures Diagnostic accuracy of nurses’ clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses’ impression that a child appeared ill. Results Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses’ clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses’ impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours. Conclusion The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.
Archives of Disease in Childhood, 2014
Background Clinical prediction rules (CPRs) are developed to aid the identification of serious in... more Background Clinical prediction rules (CPRs) are developed to aid the identification of serious infections (SI), but their value in young febrile infants remains unclear. Aim To systematically review existing CPRs and subsequently validate these CPRs in two external cohorts of young febrile infants at risk for SI in the Netherlands 1 (N = 925; ≤1 year) and Spain 2 (N = 2148; ≤3 months). Methods We included seven multivariable developed CPRs for febrile children to predict SI, including clinical predictors and/or diagnostic tests results. CPR performance was assessed by sensitivity, specificity, calibration analyses and area under the receiver operating characteristic curve (AUC). Results All CPRs (including 19 different predictors) originally performed moderate-good (AUC0.60-0.93). The original cohorts, with SI prevalence variation of 0.8-27%, varied between 381 and 5279 febrile children. Almost all CPRs were derived in emergency care populations including wide age ranges of 0-16 years. Validation of CPRs missing ≥2/3 of the required variables was not performed, resulting in limited evaluation of two CPRs including eg capillary refill time and vital signs (heart/respiratory rate) in the Spanish cohort. Four out of 7 CPRs showed acceptable ROC-areas (0.76-0.89) in both cohorts. Sensitivities of CPRs predicting high/low risks ranged from 0.60-0.93 and specificities from 0.71-0.97. Three CPRs were non-informative (AUC 0.49-0.53). Calibration slopes were mostly <1, which could indicate overestimation of predictor effects in young febrile infants. Discussion and Conclusion Four (out of 7) CPRs showed comparable performance in the identification of SI in infants ≤1 year, although with more emphasise on their rule-in value (specificity). However, predictor effects were generally overestimated.
Nederlands tijdschrift voor geneeskunde, 2014
Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from... more Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from the vast majority with self-limiting diseases at an early stage. Alarm symptoms can aid in assessing the probability of serious infections in febrile children. The combined absence of alarm symptoms is useful in ruling out serious infections. CRP and PCT values are important diagnostic markers in febrile children in hospital settings. Children without any alarm symptoms and low inflammatory markers can be treated conservatively, provided there are good instructions on reassessment. Children with amber alarm symptoms or mildly elevated inflammatory markers in whom a serious infection cannot be ruled out require clinical observation or ambulant follow-up; empirical parenteral antibiotic treatment should also be considered and easily accessible. Children with red alarm symptoms or highly elevated inflammatory markers deserve clinical observation. In children < 3 months, empirical parent...
Health technology assessment (Winchester, England), 2012
Although the vast majority of children with acute infections are managed at home, this is one of ... more Although the vast majority of children with acute infections are managed at home, this is one of the most common problems encountered in children attending emergency departments (EDs) and primary care. Distinguishing children with serious infection from those with minor or self-limiting infection is difficult. This can result in misdiagnosis of children with serious infections, which results in a poorer health outcome, or a tendency to refer or admit children as a precaution; thus, inappropriately utilising secondary-care resources. We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets. We searched MEDLINE, Medion, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Database of Abstracts of Reviews of Effects in October 2008, with an update in June 2009, using search terms that include...
Archives of Disease in Childhood, 2014
hypercatecholaminemia. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of ... more hypercatecholaminemia. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of cardiac involvement in children with severe EV71 infection.
BMJ Paediatrics Open, Sep 1, 2019
To cite: van Houten C, van de Maat JS, Naaktgeboren C, et al. Update of a clinical prediction mod... more To cite: van Houten C, van de Maat JS, Naaktgeboren C, et al. Update of a clinical prediction model for serious bacterial infections in preschool children by adding a host-protein-based assay: a diagnostic study.
BMJ Paediatrics Open
ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their he... more ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.DesignThis cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January–May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres.ResultsOverall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units...
BackgroundTo investigate the impact of the COVID-19 pandemic and infection prevention measures on... more BackgroundTo investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe.MethodsRoutine health data were extracted retrospectively from electronic patient records of children aged <16 years, presenting to 38 emergency departments (ED) in 16 European countries for the period January 2018 – May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRR) were used to compare age groups, diagnoses and outcomes.FindingsReductions in pediatric ED attendances, hospital admissions and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (incidence rate ratio (IRR) 2·62, 95% CI 2·19 to 3·13) and in children aged >12 months (12-<24 months IRR 0·89, 95% CI 0·86 to 0·92; 2-...
European Journal of Pediatrics, 2021
The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic pre... more The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016–2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9–30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48–21.2]). Abnormalities on CXR were not signi...
Journal of Antimicrobial Chemotherapy, 2021
Background Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in chil... more Background Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands. Objectives Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries. Methods We selected febrile children aged 1 month to 5 years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying eff...
Nederlands Tijdschrift voor Geneeskunde, 2015
Koorts is bij kinderen een van de meest voorkomende symptomen op de SEH. 1,2 Dit is de reden van ... more Koorts is bij kinderen een van de meest voorkomende symptomen op de SEH. 1,2 Dit is de reden van 10-20% van alle ziekenhuisopnames. 3,4 Koorts kan verschillende oorzaken hebben, die variëren van relatief onschuldige virale infecties tot ernstige bacteriële infecties (EBI's), zoals sepsis, pneumonie of urineweginfectie. Voor een arts is het van belang het kind met een EBI te herkennen te midden van de grote groep kinderen met koorts; dit is een diagnostische uitdaging. 5,6 Ter ondersteuning van artsen zijn er diverse richtlijnen en beslismodellen ontwikkeld die het risico op ernstige infecties inschatten, met als doel het verbeteren van het diagnostische traject en van de kosteneffectiviteit. 7-9 Beslismodellen geven echter vaak alleen risicoschattingen zonder adviezen over de behandeling en aanvullende diagnostiek. Bovendien ontbreken regelmatig implementatiestudies, waardoor het onduidelijk is of het gebruik van deze hulpmiddelen het handelen van de arts in de dagelijkse praktijk ook daadwerkelijk beïnvloedt. 10,11 In deze studie onderzochten we de bruikbaarheid van een klinische beslisregel voor kinderen met koorts en het effect (de impact) van toepassing van dit beslismodel op Doel Onderzoeken hoe bruikbaar een klinisch beslismodel is voor het voorspellen van het risico op ernstige bacteriële infecties (EBI's) bij kinderen met koorts op de SEH, en wat het effect is van toepassing van dit beslismodel op de dagelijkse praktijk. opzet Gerandomiseerde gecontroleerde studie. MethoDe We includeerden 439 kinderen met koorts in de leeftijd van 1 maand-15 jaar op de SEH van het Erasmus MC-Sophia Kinderziekenhuis in de periode 2010-2012. De kinderen werden willekeurig toegewezen aan de interventie-(beslismodel; n = 219) of controlegroep (routinezorg; n = 220). Het beslismodel omvat klinische kenmerken en een CRPbepaling, en genereert een risicoschatting voor de diagnoses 'pneumonie' en 'overige EBI's'. Bij hoog-risicokinderen initieerden verpleegkundigen aanvullend onderzoek op advies van het beslismodel. De primaire uitkomstmaat was het aantal correcte EBI-diagnoses. Secundaire uitkomstmaten omvatten verblijfsduur op de SEH, diagnostiek, behandeling, follow-up en medische kosten (Nederlands Trial Register: NTR2381). Resultaten Het beslismodel discrimineerde goed tussen pneumonie (n = 33; 'area under the receiver operating characteristic curve' (AUC): 0,83; 95%-BI: 0,75-0,90) en overige EBI's (n = 22; AUC: 0,81; 95%-BI: 0,72-0,90). 86% van de adviezen werden nagekomen. Er was geen verschil in het aantal correcte EBI-diagnoses tussen beide groepen. Toepassing van het beslismodel resulteerde in een afname van het aantal bloedbeeldaanvragen (14 vs. 22%; p < 0,05) en meer urine-'dipstick'-testen (71 vs. 61%; p < 0,05). ConClusie Het gebruik van een klinisch beslismodel op een universitaire kindergeneeskundige SEH heeft geen invloed op het stellen van de correcte EBI-diagnose, maar leidt wel tot een meer gestandaardiseerde benadering van het kind met koorts. *Dit onderzoek werd eerder gepubliceerd in PLOS ONE (2015;10:e0127620) met als titel 'Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial'. Afgedrukt met toestemming.
Genetics in Medicine, 2021
Purpose By incorporating major developments in genetics, ophthalmology, dermatology, and neuroima... more Purpose By incorporating major developments in genetics, ophthalmology, dermatology, and neuroimaging, to revise the diagnostic criteria for neurofibromatosis type 1 (NF1) and to establish diagnostic criteria for Legius syndrome (LGSS). Methods We used a multistep process, beginning with a Delphi method involving global experts and subsequently involving non-NF experts, patients, and foundations/patient advocacy groups. Results We reached consensus on the minimal clinical and genetic criteria for diagnosing and differentiating NF1 and LGSS, which have phenotypic overlap in young patients with pigmentary findings. Criteria for the mosaic forms of these conditions are also recommended. Conclusion The revised criteria for NF1 incorporate new clinical features and genetic testing, whereas the criteria for LGSS were created to differentiate the two conditions. It is likely that continued refinement of these new criteria will be necessary as investigators (1) study the diagnostic properti...
Emergency Medicine Australasia, 2021
ObjectivesThe Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent fo... more ObjectivesThe Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in paediatric emergency care to organise globally for the conduct of collaborative research across networks.MethodsPERN has grown from five to eight member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children.ResultsBeginning as a pandemic response studying H1N1 influenza risk factors in children, PERN research has progres...
The Lancet Regional Health - Europe, 2021
Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quali... more Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods: The MOFICHE study prospectively collected data on febrile children (0À18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included
The Lancet Infectious Diseases, 2021
European Journal of Pediatrics, 2017
With great interest, we read the paper of Falszewska et al. [1] on the diagnostic accuracy of cli... more With great interest, we read the paper of Falszewska et al. [1] on the diagnostic accuracy of clinical dehydration scales in children. They observed limited diagnostic value of the clinical dehydration scale (CDS) [2] only in ruling-in severe weight-change-based dehydration, whereas the WHO [3] and the Gorelick scale [4] showed no association. Pre-and post-illness weight change is considered the gold standard in the assessment of dehydration in children with acute gastroenteritis (AGE). However, pre-illness weight rarely is available at presentation. Similar to Falszewska, we used weight change as a reference standard of dehydration during our randomized controlled trial (NTR number 2304) on ambulant rehydration in children aged 1 month-5 years with AGE visiting the emergency department
European Journal of Human Genetics, 2020
PTEN hamartoma tumour syndrome is a diverse multi-system disorder predisposing to the development... more PTEN hamartoma tumour syndrome is a diverse multi-system disorder predisposing to the development of hamartomatous growths, increasing risk of breast, thyroid, renal cancer, and possibly increasing risk of endometrial cancer, colorectal cancer and melanoma. There is no international consensus on cancer surveillance in PHTS and all current guidelines are based on expert opinion. A comprehensive literature review was undertaken and guidelines were developed by clinicians with expertise from clinical genetics, gynaecology, endocrinology, dermatology, radiology, gastroenterology and general surgery, together with affected individuals and their representatives. Recommendations were put forward for surveillance for breast, thyroid and renal cancers. Limited recommendations were developed for other sites including endometrial, colon and skin. The proposed cancer surveillance recommendations for PHTS require a coordinated multidisciplinary approach and significant patient commitment. The ev...
The Lancet Infectious Diseases, 2019
Background Prevalence of serious bacterial infections in children in countries in western Europe ... more Background Prevalence of serious bacterial infections in children in countries in western Europe and the USA is low. Antibiotic stewardship aims at a more rational use of antibiotics but information on the frequency of antibiotic prescription to children in emergency departments is scarce. We aimed to quantify and explain variability in antibiotic prescription in children attending European paediatric emergency departments. Methods We did a cross-sectional, observational study of children aged between 1 month and 16 years who presented with fever to one of 28 European emergency departments on one random sampling day per month between Nov 1, 2014, and Feb 28, 2016. The surveyed sites were spread across 11 countries and included 17 academic hospitals with 3000 to up to 80 000 annual visits to their paediatric emergency departments. We determined the proportion of children without comorbidities who received antibiotic prescriptions by country, focus of infection, and type of antibiotic. We then did a detailed analysis of the same population, using a multilevel logistic regression analysis, into the variability in prescriptions across hospitals, focusing particularly on respiratory tract infections and correcting for a combination of result-dependent factors. Random group assignment was done by computer randomisation. Findings Of 5177 children in total, 617 children had comorbidities. Of the 4560 children without comorbidities, 1454 (32%) received antibiotics. This percentage varied from 19% to 64% across countries. Of these 1454 prescriptions issued, 893 (61%) were second-line antibiotics. Antibiotic prescription for respiratory tract infections, the most common infection type, in children without comorbidities was most variable across countries (15-67% for upper respiratory tract infections and 24-87% for lower respiratory tract infections) and was associated with age (odds ratio [OR] 1•51, 95% CI 1•08-2•13), fever duration (OR 1•45, 1•01-2•07), blood concentrations of C-reactive protein (OR 2•31, 1•67-3•19), and chest x-ray results (OR 10•62, 5•65-19•94, for focal abnormalities; OR 3•49, 1•59-7•64, for diffuse abnormalities). After correcting for patient characteristics, diagnostic assessment, and hospital characteristics, antibiotic prescription for respiratory tract infections remained highly variable across emergency departments (standardised antibiotic prescription ratio 0•49-2•04). Interpretation Antibiotic prescription in European emergency departments is highly variable, with frequent use of second-line antibiotics. To ensure successful antibiotic stewardship initiatives in Europe aimed at reducing unnecessary prescription of antibiotics, variability of prescription across hospitals should be considered, drivers of suboptimal antibiotic prescription at the local level need to be identified, and European guidelines need to be devised.
Journal of Autism and Developmental Disorders, 2018
In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of a... more In a non-selected sample of children with Neurofibromatosis type 1 (NF1) the prevalence rate of autism spectrum disorder (ASD) and predictive value of an observational (ADOS)-and questionnaire-based screening instrument were assessed. Complete data was available for 128 children. The prevalence rate for clinical ASD was 10.9%, which is clearly higher than in the general population. This prevalence rate is presumably more accurate than in previous studies that examined children with NF1 with an ASD presumption or solely based on screening instruments. The combined observational-and screening based classifications demonstrated the highest positive predictive value for DSM-IV diagnosis, highlighting the importance of using both instruments in children with NF1.
Archives of Disease in Childhood, 2012
Archives of Disease in Childhood, 2017
Objective To assess the diagnostic value and determinants of nurses’ clinical impression for the ... more Objective To assess the diagnostic value and determinants of nurses’ clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). Design Secondary analysis of a prospective cohort. Setting and patients 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. Main outcome measures Diagnostic accuracy of nurses’ clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses’ impression that a child appeared ill. Results Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses’ clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses’ impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours. Conclusion The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.
Archives of Disease in Childhood, 2014
Background Clinical prediction rules (CPRs) are developed to aid the identification of serious in... more Background Clinical prediction rules (CPRs) are developed to aid the identification of serious infections (SI), but their value in young febrile infants remains unclear. Aim To systematically review existing CPRs and subsequently validate these CPRs in two external cohorts of young febrile infants at risk for SI in the Netherlands 1 (N = 925; ≤1 year) and Spain 2 (N = 2148; ≤3 months). Methods We included seven multivariable developed CPRs for febrile children to predict SI, including clinical predictors and/or diagnostic tests results. CPR performance was assessed by sensitivity, specificity, calibration analyses and area under the receiver operating characteristic curve (AUC). Results All CPRs (including 19 different predictors) originally performed moderate-good (AUC0.60-0.93). The original cohorts, with SI prevalence variation of 0.8-27%, varied between 381 and 5279 febrile children. Almost all CPRs were derived in emergency care populations including wide age ranges of 0-16 years. Validation of CPRs missing ≥2/3 of the required variables was not performed, resulting in limited evaluation of two CPRs including eg capillary refill time and vital signs (heart/respiratory rate) in the Spanish cohort. Four out of 7 CPRs showed acceptable ROC-areas (0.76-0.89) in both cohorts. Sensitivities of CPRs predicting high/low risks ranged from 0.60-0.93 and specificities from 0.71-0.97. Three CPRs were non-informative (AUC 0.49-0.53). Calibration slopes were mostly <1, which could indicate overestimation of predictor effects in young febrile infants. Discussion and Conclusion Four (out of 7) CPRs showed comparable performance in the identification of SI in infants ≤1 year, although with more emphasise on their rule-in value (specificity). However, predictor effects were generally overestimated.
Nederlands tijdschrift voor geneeskunde, 2014
Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from... more Febrile children pose the diagnostic dilemma of distinguishing those with serious infections from the vast majority with self-limiting diseases at an early stage. Alarm symptoms can aid in assessing the probability of serious infections in febrile children. The combined absence of alarm symptoms is useful in ruling out serious infections. CRP and PCT values are important diagnostic markers in febrile children in hospital settings. Children without any alarm symptoms and low inflammatory markers can be treated conservatively, provided there are good instructions on reassessment. Children with amber alarm symptoms or mildly elevated inflammatory markers in whom a serious infection cannot be ruled out require clinical observation or ambulant follow-up; empirical parenteral antibiotic treatment should also be considered and easily accessible. Children with red alarm symptoms or highly elevated inflammatory markers deserve clinical observation. In children < 3 months, empirical parent...
Health technology assessment (Winchester, England), 2012
Although the vast majority of children with acute infections are managed at home, this is one of ... more Although the vast majority of children with acute infections are managed at home, this is one of the most common problems encountered in children attending emergency departments (EDs) and primary care. Distinguishing children with serious infection from those with minor or self-limiting infection is difficult. This can result in misdiagnosis of children with serious infections, which results in a poorer health outcome, or a tendency to refer or admit children as a precaution; thus, inappropriately utilising secondary-care resources. We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets. We searched MEDLINE, Medion, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Database of Abstracts of Reviews of Effects in October 2008, with an update in June 2009, using search terms that include...
Archives of Disease in Childhood, 2014
hypercatecholaminemia. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of ... more hypercatecholaminemia. Plasma BNP is a sensitive and reliable cardiac biomarker for detection of cardiac involvement in children with severe EV71 infection.