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Febrile EValuation of children in the Emergency Room

Aim: To determine whether a computer decision support system improves the outcomes of children presenting with a febrile illness.

Background: Clinical diagnosis is based on clinical judgement and expertise together with diagnostic test results. This is a complex task involving interpretation of patient results in the context of pre-test probability of disease and test accuracy. Extra complexity occurs with multiple tests, which inevitably occurs once a history and physical examination are taken. This project develops and tests a system that incorporates all components to give the clinician an explicit probability of disease.

Research Plan

Phase 1. (1 Jul 2004 - 30 June 2006) Children less than 5 years old presenting to the Emergency Department at The Children’s Hospital at Westmead with a febrile illness were eligible for the study. Information about each child’s illness was collected and children were followed by research staff until diagnosis of a serious bacterial illness or resolution of the illness. Data were analysed for predictors of serious bacterial infection and an algorithm was developed to calculate risk of infection of the 3 most common serious bacterial infections (urinary tract infection, pneumonia and Bacteraemia) in each child. Results from this component of the study were published in the BMJ in 2010

Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, Irwig L, Fitzgerald DA, Isaacs D, McCaskill M. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses BMJ. 2010 Apr 20;340:c1594. doi: 10.1136/bmj.c1594.Abstract

Phase 2. (20 Februay2007 – 19 February 2009) A cluster randomised trial was designed to test whether provision of the additional information about risk in febrile children influences health outcomes. Doctors assessing children in the Emergency Department were randomised to receive the additional computer decision support system or not and all children were followed to determine whether this decision support system resulted in improved patient outcomes. Results of the trial are compiled and the finalised article will be submitted for publication during 2011.