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Article ; Online: A severe influenza season in Austria and its impact on the paediatric population

Benno Kohlmaier / Vendula Svendova / Thomas Walcher / Heidemarie Pilch / Larissa Krenn / Herbert Kurz / Karl Zwiauer / Werner Zenz / for the Austrian Paediatric Influenza Network

BMC Public Health, Vol 20, Iss 1, Pp 1-

mortality and hospital admission rates, november 2017 - march 2018

2020 Volume 9

Abstract: Abstract Background In Austria paediatric influenza-associated hospitalisations and deaths have never been systematically monitored. We examined the influenza season 2017/18 in terms of hospitalisation and mortality in the Austrian paediatric population ... ...

Abstract	Abstract Background In Austria paediatric influenza-associated hospitalisations and deaths have never been systematically monitored. We examined the influenza season 2017/18 in terms of hospitalisation and mortality in the Austrian paediatric population and put the results into perspective of the available data from the last 15 years. Methods Cases of influenza-associated hospitalisations and deaths for season 2017/18 in children below 18 years were retrospectively collected from 12 and 33 Austrian hospitals, respectively. Hospitalisation and mortality rates for the whole Austrian paediatric population were estimated, adjusting for the population in each catchment area. Two Austrian databases were queried for hospitalisations and deaths associated with influenza during 2002–2016. Rough estimate of the vaccination coverage was calculated from a survey on 100 inpatients. Results Influenza-related paediatric hospitalisation rate in season 2017/18 was estimated as 128 (CI: 122–135) per 100,000 children, much higher than the national average of 40 per 100,000 over the years 2002–2016. There were nine reported influenza-associated deaths among children, resulting in mortality rate of 0.67 (CI: 0.32–1.21) per 100,000 children. Conclusions Reported influenza-associated hospitalisations and fatalities demonstrate a high burden of influenza in the Austrian paediatric population corresponding with very low vaccination coverage.
Keywords	Influenza ; Children ; Hospital admission rates ; Mortality ; Vaccination ; Austria ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2020-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics and management of adolescents attending the ED with fever

BMJ Open, Vol 12, Iss

a prospective multicentre study

2022 Volume 1

Keywords	Medicine ; R
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sex differences in febrile children with respiratory symptoms attending European emergency departments

Chantal D. Tan / Soufiane el Ouasghiri / Ulrich von Both / Enitan D. Carrol / Marieke Emonts / Michiel van der Flier / Ronald de Groot / Jethro Herberg / Benno Kohlmaier / Michael Levin / Emma Lim / Ian K. Maconochie / Federico Martinon-Torres / Ruud G. Nijman / Marko Pokorn / Irene Rivero-Calle / Maria Tsolia / Clementien L. Vermont / Werner Zenz /

Dace Zavadska / Henriette A. Moll / Joany M. Zachariasse / On behalf of PERFORM consortium (Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union)

PLoS ONE, Vol 17, Iss

An observational multicenter study

2022 Volume 8

Abstract: Objective To assess sex differences in presentation and management of febrile children with respiratory symptoms attending European Emergency Departments. Design and setting An observational study in twelve Emergency Departments in eight European ... ...

Abstract	Objective To assess sex differences in presentation and management of febrile children with respiratory symptoms attending European Emergency Departments. Design and setting An observational study in twelve Emergency Departments in eight European countries. Patients Previously healthy children aged 0–<18 years with fever (≥ 38°C) at the Emergency Department or in the consecutive three days before Emergency Department visit and respiratory symptoms were included. Main outcome measures The main outcomes were patient characteristics and management defined as diagnostic tests, treatment and admission. Descriptive statistics were used for patient characteristics and management stratified by sex. Multivariable logistic regression analyses were performed for the association between sex and management with adjustment for age, disease severity and Emergency Department. Additionally, subgroup analyses were performed in children with upper and lower respiratory tract infections and in children below five years. Results We included 19,781 febrile children with respiratory symptoms. The majority were boys (54%), aged 1–5 years (58%) and triaged as low urgent (67%). Girls presented less frequently with tachypnea (15% vs 16%, p = 0.002) and increased work of breathing (8% vs 12%, p<0.001) compared with boys. Girls received less inhalation medication than boys (aOR 0.82, 95% CI 0.74–0.90), but received antibiotic treatment more frequently than boys (aOR 1.09, 95% CI 1.02–1.15), which is associated with a higher prevalence of urinary tract infections. Amongst children with a lower respiratory tract infection and children below five years girls received less inhalation medication than boys (aOR 0.77, 95% CI 0.66–0.89; aOR 0.80, 95% CI 0.72–0.90). Conclusions Sex differences concerning presentation and management are present in previously healthy febrile children with respiratory symptoms presenting to the Emergency Department. Future research should focus on whether these differences are related to clinicians’ attitudes, ...
Keywords	Medicine ; R ; Science ; Q
Subject code	150
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sex differences in febrile children with respiratory symptoms attending European emergency departments

Chantal D Tan / Soufiane El Ouasghiri / Ulrich von Both / Enitan D Carrol / Marieke Emonts / Michiel van der Flier / Ronald de Groot / Jethro Herberg / Benno Kohlmaier / Michael Levin / Emma Lim / Ian K Maconochie / Federico Martinon-Torres / Ruud G Nijman / Marko Pokorn / Irene Rivero-Calle / Maria Tsolia / Clementien L Vermont / Werner Zenz /

Dace Zavadska / Henriette A Moll / Joany M Zachariasse / PERFORM consortium (Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union)

PLoS ONE, Vol 17, Iss 8, p e

An observational multicenter study.

2022 Volume 0271934

Abstract	Objective To assess sex differences in presentation and management of febrile children with respiratory symptoms attending European Emergency Departments. Design and setting An observational study in twelve Emergency Departments in eight European countries. Patients Previously healthy children aged 0-<18 years with fever (≥ 38°C) at the Emergency Department or in the consecutive three days before Emergency Department visit and respiratory symptoms were included. Main outcome measures The main outcomes were patient characteristics and management defined as diagnostic tests, treatment and admission. Descriptive statistics were used for patient characteristics and management stratified by sex. Multivariable logistic regression analyses were performed for the association between sex and management with adjustment for age, disease severity and Emergency Department. Additionally, subgroup analyses were performed in children with upper and lower respiratory tract infections and in children below five years. Results We included 19,781 febrile children with respiratory symptoms. The majority were boys (54%), aged 1-5 years (58%) and triaged as low urgent (67%). Girls presented less frequently with tachypnea (15% vs 16%, p = 0.002) and increased work of breathing (8% vs 12%, p<0.001) compared with boys. Girls received less inhalation medication than boys (aOR 0.82, 95% CI 0.74-0.90), but received antibiotic treatment more frequently than boys (aOR 1.09, 95% CI 1.02-1.15), which is associated with a higher prevalence of urinary tract infections. Amongst children with a lower respiratory tract infection and children below five years girls received less inhalation medication than boys (aOR 0.77, 95% CI 0.66-0.89; aOR 0.80, 95% CI 0.72-0.90). Conclusions Sex differences concerning presentation and management are present in previously healthy febrile children with respiratory symptoms presenting to the Emergency Department. Future research should focus on whether these differences are related to clinicians' attitudes, ...
Keywords	Medicine ; R ; Science ; Q
Subject code	150
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk Factors for Complicated Lymphadenitis Caused by Nontuberculous Mycobacteria in Children

Martin Kuntz / Daniela S. Kohlfürst / Cornelia Feiterna-Sperling / Renate Krüger / Ulrich Baumann / Laura Buchtala / Roland Elling / Veit Grote / Johannes Hübner / Markus Hufnagel / Petra Kaiser-Labusch / Johannes Liese / Eva-Maria Otto / Markus A. Rose / Christian Schneider / Volker Schuster / Maximilian Seidl / Olaf Sommerburg / Markus Vogel /

Horst von Bernuth / Michael Weiß / Theodor Zimmermann / Alexandra Nieters / Werner Zenz / Philipp Henneke

Emerging Infectious Diseases, Vol 26, Iss 3, Pp 579-

2020 Volume 586

Abstract: Nontuberculous mycobacteria (NTM) are an emerging cause of infections, including chronic lymphadenitis in children. To identify risk factors for NTM lymphadenitis, particularly complicated disease, we collected epidemiologic, clinical, and ... ...

Abstract	Nontuberculous mycobacteria (NTM) are an emerging cause of infections, including chronic lymphadenitis in children. To identify risk factors for NTM lymphadenitis, particularly complicated disease, we collected epidemiologic, clinical, and microbiological data on 138 cases of NTM lymphadenitis in children across 13 centers in Germany and Austria. We assessed lifestyle factors but did not identify specific risk behaviors. We noted that more cases of NTM lymphadenitis occurred during cold months than during warm months. Moreover, we noted female sex and age <5.5 years as potential risk factors. Complete extirpation of the affected lymph node appeared to be the best therapeutic measure. We integrated the study data to develop a simple risk score to predict unfavorable clinical outcomes for NTM lymphadenitis.
Keywords	Nontuberculous mycobacteria ; lymphadenitis ; epidemiology ; risk factors ; bacteria ; Germany ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2020-03-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe

Dorine M Borensztajn / Nienke N Hagedoorn / Irene Rivero Calle / Ian K Maconochie / Ulrich von Both / Enitan D Carrol / Juan Emmanuel Dewez / Marieke Emonts / Michiel van der Flier / Ronald de Groot / Jethro Herberg / Benno Kohlmaier / Emma Lim / Federico Martinon-Torres / Daan Nieboer / Ruud G Nijman / Marko Pokorn / Franc Strle / Maria Tsolia /

Clementien Vermont / Shunmay Yeung / Dace Zavadska / Werner Zenz / Michael Levin / Henriette A Moll / PERFORM consortium: Personalised Risk assessment in febrile children to optimise Real-life Management across the European Union

PLoS ONE, Vol 16, Iss 1, p e

PERFORM, a multicentre prospective observational study.

2021 Volume 0244810

Abstract: Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, ... ...

Abstract	Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0-18 years presenting to 12 European EDs (2017-2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1-54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1-5.0), PICU admission rates (0.2-2.2), upper respiratory tract infections (0.4-1.7) and fever without focus (0.5-2.7). Variation was small in sepsis/meningitis (0.9-1.1). Conclusions Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A NICE combination for predicting hospitalisation at the Emergency Department

Dorine M. Borensztajn / Nienke N. Hagedoorn / Enitan D. Carrol / Ulrich von Both / Juan Emmanuel Dewez / Marieke Emonts / Michiel van der Flier / Ronald de Groot / Jethro Herberg / Benno Kohlmaier / Emma Lim / Ian K. Maconochie / Federico Martinon-Torres / Daan Nieboer / Ruud G. Nijman / Rianne Oostenbrink / Marko Pokorn / Irene Rivero Calle / Franc Strle /

Maria Tsolia / Clementien L. Vermont / Shunmay Yeung / Dace Zavadska / Werner Zenz / Michael Levin / Henriette A. Moll

The Lancet Regional Health. Europe, Vol 8, Iss , Pp 100173- (2021)

a European multicentre observational study of febrile children

2021

Abstract: Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to ... ...

Abstract	Background: Prolonged Emergency Department (ED) stay causes crowding and negatively impacts quality of care. We developed and validated a prediction model for early identification of febrile children with a high risk of hospitalisation in order to improve ED flow. Methods: The MOFICHE study prospectively collected data on febrile children (0–18 years) presenting to 12 European EDs. A prediction models was constructed using multivariable logistic regression and included patient characteristics available at triage. We determined the discriminative values of the model by calculating the area under the receiver operating curve (AUC). Findings: Of 38,424 paediatric encounters, 9,735 children were admitted to the ward and 157 to the PICU. The prediction model, combining patient characteristics and NICE alarming, yielded an AUC of 0.84 (95%CI 0.83-0.84).The model performed well for a rule-in threshold of 75% (specificity 99.0% (95%CI 98.9-99.1%, positive likelihood ratio 15.1 (95%CI 13.4-17.1), positive predictive value 0.84 (95%CI 0.82-0.86)) and a rule-out threshold of 7.5% (sensitivity 95.4% (95%CI 95.0-95.8), negative likelihood ratio 0.15 (95%CI 0.14-0.16), negative predictive value 0.95 (95%CI 0.95-9.96)). Validation in a separate dataset showed an excellent AUC of 0.91 (95%CI 0.90- 0.93). The model performed well for identifying children needing PICU admission (AUC 0.95, 95%CI 0.93-0.97). A digital calculator was developed to facilitate clinical use. Interpretation: Patient characteristics and NICE alarming signs available at triage can be used to identify febrile children at high risk for hospitalisation and can be used to improve ED flow. Funding: European Union, NIHR, NHS.
Keywords	Emgerency Department ; Febrile children ; Crowding ; Admission prediction ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical Characteristics of Patients with Tick-Borne Encephalitis (TBE)

Benno Kohlmaier / Nina A. Schweintzger / Manfred G. Sagmeister / Vendula Švendová / Daniela S. Kohlfürst / Astrid Sonnleitner / Manuel Leitner / Andrea Berghold / Erich Schmiedberger / Franz Fazekas / Alexander Pichler / Jana Rejc-Marko / Daniel Růžek / Lucie Dufková / Darina Čejková / Petr Husa / Martina Pýchová / Lenka Krbková / Václav Chmelík /

Věra Štruncová / Dace Zavadska / Guntis Karelis / Aukse Mickiene / Joanna Zajkowska / Petra Bogovič / Franc Strle / Werner Zenz / the EU-TICK-BO STUDY GROUP

Microorganisms, Vol 9, Iss 1420, p

A European Multicentre Study from 2010 to 2017

2021 Volume 1420

Abstract: Tick-borne encephalitis (TBE) virus is a major cause of central nervous system infections in endemic countries. Here, we present clinical and laboratory characteristics of a large international cohort of patients with confirmed TBE using a uniform ... ...

Abstract	Tick-borne encephalitis (TBE) virus is a major cause of central nervous system infections in endemic countries. Here, we present clinical and laboratory characteristics of a large international cohort of patients with confirmed TBE using a uniform clinical protocol. Patients were recruited in eight centers from six European countries between 2010 and 2017. A detailed description of clinical signs and symptoms was recorded. The obtained information enabled a reliable classification in 553 of 555 patients: 207 (37.3%) had meningitis, 273 (49.2%) meningoencephalitis, 15 (2.7%) meningomyelitis, and 58 (10.5%) meningoencephalomyelitis; 41 (7.4%) patients had a peripheral paresis of extremities, 13 (2.3%) a central paresis of extremities, and 25 (4.5%) had single or multiple cranial nerve palsies. Five (0.9%) patients died during acute illness. Outcome at discharge was recorded in 298 patients. Of 176 (59.1%) patients with incomplete recovery, 80 (27%) displayed persisting symptoms or signs without recovery expectation. This study provides further evidence that TBE is a severe disease with a large proportion of patients with incomplete recovery. We suggest monitoring TBE in endemic European countries using a uniform protocol to record the full clinical spectrum of the disease.
Keywords	tick-borne encephalitis ; vaccine-preventable disease ; meningomyelitis ; central paresis ; peripheral paresis ; Biology (General) ; QH301-705.5
Subject code	610 ; 616
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mycobacterium bohemicum and Cervical Lymphadenitis in Children

Julia Huber / Elvira Richter / Lothar Binder / Matthias Maa / Robert Eberl / Werner Zenz

Emerging Infectious Diseases, Vol 14, Iss 7, Pp 1158-

2008 Volume 1159

Keywords	Mycobacterium bohemicum ; nontuberculous mycobacterium ; cervical lymphadenitis ; letter ; Austria ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2008-07-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Variation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE)

Nienke N Hagedoorn / Dorine M Borensztajn / Ruud Nijman / Anda Balode / Ulrich von Both / Enitan D Carrol / Irini Eleftheriou / Marieke Emonts / Michiel van der Flier / Ronald de Groot / Jethro Herberg / Benno Kohlmaier / Emma Lim / Ian Maconochie / Federico Martinon-Torres / Daan Nieboer / Marko Pokorn / Franc Strle / Maria Tsolia /

Shunmay Yeung / Dace Zavadska / Werner Zenz / Clementien Vermont / Michael Levin / Henriëtte A Moll / PERFORM consortium

PLoS Medicine, Vol 17, Iss 8, p e

A multicentre observational study.

2020 Volume 1003208

Abstract: Background The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions ...

Abstract	Background The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. Methods and findings Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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