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Predictors of fever-related admissions to a paediatric assessment unit, ward and reattendances in a South London emergency department: the CABIN 2 study
  1. Amaya L Bustinduy1,
  2. Irina Chis Ster2,
  3. Rebecca Shaw1,3,
  4. Adam Irwin1,
  5. Jaiganesh Thiagarajan3,
  6. Rhys Beynon3,
  7. Shamez Ladhani1,4,
  8. Mike Sharland1
  9. for the CABIN network
  1. 1Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University of London, London, UK
  2. 2Institute of Infection and Immunity, St George's University of London, London, UK
  3. 3Children's Emergency Department, St George's NHS trust, London, UK
  4. 4Immunisation Department, Public Health England, London, UK
  1. Correspondence to Dr Amaya L Bustinduy, Clinical Research Department, London School of Hygiene & Tropical Medicine, Room 358, Keppel Street, London WC1E 7HT, UK; Amaya.Bustinduy{at}


Objective To explore the risk factors for ward and paediatric assessment unit (PAU) admissions from the emergency department (ED).

Design Prospective observational study.

Setting and patients Febrile children attending a large tertiary care ED during the winter of 2014–2015.

Main outcome measures Ward and PAU admissions, National Institute for Health and Care Excellence (NICE) guidelines classification, reattendance to the ED within 28 days and antibiotic use.

Results A total of 1097 children attending the children's ED with fever were analysed. Risk factors for PAU admission were tachycardia (RR=1.1, 95% CI (1 to 1.1)), ill-appearance (RR=2.2, 95% CI (1.2 to 4.2)), abnormal chest findings (RR=2.1, 95% CI (1.2 to 4.3)), categorised as NICE amber (RR 1.7 95% CI (1.2 to 2.5)). There was a 30% discordance between NICE categorisation at triage and statistical internal validation. Predictors of ward admission were a systemic (RR=6.9, 95% CI (2.4 to 19.8)) or gastrointestinal illness (RR=3.8, 95% (1.4 to 10.4)) and categorised as NICE Red (RR=5.9, 95% CI (2.2 to 15.3)). Only 51 children had probable bacterial pneumonia (4.6%), 52 children had a proven urinary tract infection (4.2%), with just 2 (0.2%) positive blood cultures out of 485 (44%) children who received an antibiotic. 15% of all children reattended by 28 days and were more likely to have been categorised as Amber and had investigations on initial visit.

Conclusions Risk factors for PAU and ward admissions are different in this setting with high reattendance rates and very low proportion of confirmed/probable serious bacterial infections. Future studies need to focus on reducing avoidable admissions and antibiotic treatment.

  • Accident & Emergency
  • General Paediatrics
  • Health services research
  • Infectious Diseases
  • Outcomes research

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  • Twitter Follow Adam Irwin at @adamdirwin

  • Contributors MS, JT and RB conceived the work; AB, RS collected and entered the data; ICS performed the statistical planning and main analyses AB, ICS, AI, analysed the data; AB wrote the manuscript; SL, MS, JT and RB reviewed and edited the manuscript.

  • Funding This work was supported by the Wandsworth Clinical Commisioning group, grant number 13-14-060.

  • Competing interests None declared.

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