Comparison of Paediatric Patient Flow Following Presentations of Fever in the Community Versus Hospital Setting

Abstract

Introduction: Fever is a common paediatric presentation in both the hospital and community setting. However, there is a widespread perception that febrile children who present to community or hospital settings receive different investigations and follow-up, potentially impacting on patient outcomes.

Aim: To compare paediatric presentations of fever in hospital vs community settings in regard to patient flow investigations, follow-up arrangements and advice given.

Materials and Methods: Retrospective analysis of Clinical Audit Project database, containing demographic and clinical parameters relating to patients surveyed from a period inclusive of 2007-2012 and additionally 2014, was performed. From this data set, records relating to 319 paediatric patients were included in the final analysis with inclusion criteria of age <= 16 years and fever. Data were compared between community and hospital locations by chi-square test with continuity correction where appropriate.

Results: Of the 319 patients analysed, 265 (83.1%) were surveyed in the hospital and 54 (16.9%) were surveyed in the community. Within the hospital setting, 133 (50.2%) patients had at least one investigation, while in the community group only 7 (13%) patients did (p<0.001). Almost all patients received follow-up (n=305, 95.6%). The largest number of no follow-up patients was found in the subgroup of community patients who received no investigations.

Conclusion: Significant differences in patient flow exist in paediatric patients presenting with fever, in hospital versus community settings in this dataset. Further research is required to delineate these differences. This data may provide direction for future studies of resource distribution and patient outcomes in hospital and community settings.