Trial reportPloS one2015
Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial.
Trial report in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Pediatric Predictive Artificial Intelligence Implemented in Clinical Practice from 2010 to 2021: A Systematic Review.Applied clinical informatics · 2025Pooled it
- Clinical prediction models for serious infections in children: external validation in ambulatory care.BMC medicine · 2023Trial
- Trial
- Diagnostic testing and antibiotic stewardship for pneumonia in children worldwide: current developments and next steps.Current opinion in pediatrics · 2025Review
- A Blueprint for Clinical-Driven Medical Device Development: The Feverkidstool Application to Identify Children With Serious Bacterial Infection.Mayo Clinic proceedings. Digital health · 2024Article
- Adoption of C-reactive protein rapid tests for the management of acute childhood infections in hospitals in the Netherlands and England: a comparative health systems analysis.BMC health services research · 2024Article
- Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department.Frontiers in pediatrics · 2022Article
- A Novel Framework for Phenotyping Children With Suspected or Confirmed Infection for Future Biomarker Studies.Frontiers in pediatrics · 2021Article
- Article
- 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 · 2019Article
- Can clinical prediction models assess antibiotic need in childhood pneumonia? A validation study in paediatric emergency care.PloS one · 2019Article
- Characteristics of revisits of children at risk for serious infections in pediatric emergency care.European journal of pediatrics · 2018Article
- Antibiotic Use in Febrile Children Presenting to the Emergency Department: A Systematic Review.Frontiers in pediatrics · 2018Article
- Fever in Children: Pearls and Pitfalls.Children (Basel, Switzerland) · 2017Review
- Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs.The western journal of emergency medicine · 2017Article
- Systematic review of the effects of care provided with and without diagnostic clinical prediction rules.Diagnostic and prognostic research · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI) attending the emergency department (ED).
methodsRandomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n = 219) or the control group (usual care; n = 220). The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. The clinical decision model was evaluated by 1) area-under-the-receiver-operating-characteristic-curve (AUC) to indicate discriminative ability and 2) feasibility, to measure nurses' compliance to model recommendations. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.
resultsThe decision model had good discriminative ability for both pneumonia (n = 33; AUC 0.83 (95% CI 0.75-0.90)) and other SBI (n = 22; AUC 0.81 (95% CI 0.72-0.90)). Compliance to model recommendations was high (86%). No differences in correct SBI determination were observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value < 0.05) and more urine-dipstick testing (71% vs. 61%, p-value < 0.05).
conclusionsIn contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved, however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing.
trial registrationNederlands Trial Register NTR2381.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.