Background Safety netting strategies after emergency department (ED) discharge are mostly not standardised.
Aim To develop a safety netting protocol for children at risk for serious infections (SI) discharged from the ED.
Methods Patients: Children with fever, vomiting/diarrhoea or dyspnoea (1 month-16 years).
Design: Systematic Literature Review to Select Best Evidence for Determinants of ED-Revisits and Prospective Cohort Study
Setting: ED of Erasmus MC-Sophia Children’s Hospital (May 2010–December 2012)
Intervention Standardised telephonic questionnaires on disease course three days after ED-discharge.
OutcomeED-Revisits with Intervention (Diagnostics or Treatment)
Analysis All determinants and time until ED-revisits were tested by multivariable logistic regression and Kaplan-Meier survival analysis.
Results (Preliminary) Follow-up data were available for 1366/1656(83%) children, median age 21 months (IQR10–45), 57% boys. 856(63%) were febrile children, 300(22%) children suffered from vomiting/diarrhoea and 210(15%) children had dyspnoea. Overall there were 401(29%) revisits in which 54% (n = 216) interventions were performed.
We confirmed the determinants: age <1 year, respiratory/circulatory symptoms and signs of dehydration, as identified in our systematic review, associated with ED-revisits. Additional, parental concern was a determinant for revisit in febrile children. Unscheduled revisits of children with vomiting/diarrhoea occurred mostly within one day and in febrile or dyspnoeic children within 2 days after initial ED-visit.
Discussion and conclusion We identified strong determinants of revisits by prospective data collection in ED-discharged children at risk for SI. We are preparing a multicentre efficacy study to use these determinants and time frames in ED safety netting management.
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