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Barriers to translating diagnostic research in febrilechildren to clinical practice: a systematic review
  1. Rianne Oostenbrink1,
  2. Matthew Thompson2,
  3. Ewout W Steyerberg3 ERNIE members
  1. 1Pediatric Ambulatory Care, Erasmus MC – Sophia, Rotterdam, The Netherlands
  2. 2Department of Primary Health Care, University of Oxford, Oxford, UK
  3. 3Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Rianne Oostenbrink, Pediatric Ambulatory Care, Erasmus MC Rotterdam, Dr Molewaterplein 60, Room Sp 1549, 3015 GJ Rotterdam, The Netherlands; r.oostenbrink{at}


Background Although the topic of identifying febrile children at risk of serious infections has been addressed by numerous research groups, identified predictors remain diverse and implementation of results in routine practice has been limited. The aim of this paper is to discuss the problems and challenges in advancing diagnostic research in febrile children.

Methods The characteristics and results of 35 studies identified from a systematic review on predictors for febrile children were evaluated.

Results Current diagnostic research is mainly performed in subpopulations, defined by age and temperature limits and in paediatric emergency settings, ignoring the role of primary care. It is characterised by a dichotomous approach of outcomes and a wide variability of potential predictors. Validation of results to other settings and impact studies of prediction rules on patient outcomes are scarce. In designing diagnostic studies on children suspected of serious infections focus is needed on all clinically relevant populations within the spectrum of primary care and emergency department settings. Consensus is also needed on the definition of fever, the concept of serious infection and the set of predictors to focus on. The heterogeneity of patients in different settings and countries stress the need for continuous updating of prediction rules in routine practice. Broad validation in different clinical settings and countries and impact analysis in routine care is essential.

Conclusions Scientists in the field of diagnosis of serious infection in children must agree on core design features to be incorporated in all studies in the area of diagnostic research in febrile children. This will improve evidence from future studies, and their generalisability and implementation in routine practice.

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  • Funding RO is financed by an unrestricted grant from Europe Container Terminals B V and by a grant from the European Society of Pediatric Infectious Diseases. MT is supported by NIHR HTA Project 07/37/05: ‘Systematic review and validation of clinical prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care’.

  • Competing interests None.

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