Programme no. 440-OP
Quality Improvement
Children with fever and respiratory infections in out-of-hours services in Norway
Ingrid Keilegavlen Rebnord*1, Hogne Sandvik2, Steinar Hunskaar3
1National Centre for Emergency Primary Health Care,Uni Research Health,Bergen,Norway;Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway, 2National Centre for Emergency Primary Health Care,Uni Research Health,Bergen,Norway, 3Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway;National Centre for Emergency Primary Health Care,Uni Research Health,Bergen,Norway
* = Presenting author
Objectives: The aim of this study was to investigate what symptoms and clinical findings were associated with most serious infections at OOH-services and if the frequent use of CRP was of diagnostic significance for the choice of treatment and use of antibiotics.
Background: Many out of hours (OOH) contacts are related to infections and respiratory sickness, especially in the youngest age group, and in the winter seasons. Many contacts are non-urgent in a strict medical sense. On site measurement of C-reactive protein (CRP) is the most frequent laboratory test in Norwegian OOH, used in 60% of all contacts with children with infections and respiratory diseases. CRP is aimed to differentiate between bacterial infections, viral and/or not serious infections and to keep the use of antibiotics as low as possible. Nevertheless, the use of antibiotics has increased since the test was introduced as a point of care test. Several studies have investigated the diagnostic value of laboratory tests for children with fever, but not in primary health care were the prevalence of serious bacterial infections is low.
Results: The inclusion is in progress, we plan to include 500 children and per December 2014 217 children are included. Based on an interim analysis of first 217 patients the use of CRP and the antibiotic prescription was more frequent at OOH-services than at the pediatric unit, but there were no significant differences in the different CRP groups. The only clinical finding of significant value for serious illness (referral to hospital) was a high respiratory frequency. More results will be presented at the Nordic Congress of General Practice in June 2015.
Material/Methods: Randomized controlled observational study at OOH-services in Norway.

Inclusion: Children < 7 year, presenting fever and/or respiratory symptoms to an OOH-service or a paediatric emergency unit.

Randomizing: 1/3 randomized to take CRP before the consultation; else the doctor decides if the test is needed giving approximately 1/3 with CRP and 1/3 without.

Data: clinical data from the consultation, questionnaire to parents before the consultations and 7 days after.

Conclusion: The use of CRP and antibiotic prescription are more frequent at OOH-services than at a paediatric emergency unit. It seems that primary care physicians consider respiratory frequency as the most important sign in children with acute fever and respiratory illness.
Points for discussion: The importance of CRP in the decision of treatment when the patient is a child with fever or respiratory symptoms.