BACKGROUND Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children. METHODS Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were sampled from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by individual indicator, phase of care, age-group and setting. RESULTS The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1-54.6), 77.5% (95% CI: 65.3-87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3-79.3) for treatment-related indicators. Adherence for children < 3 months of age was 73.4% (95% CI: 58.0-85.8) and 64.7% (95% CI: 57.0-71.9) for children 3-11 months of age, both significantly higher than for children aged 4-15 years (53.5%; 95% CI: 50.0-56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2-80.6) and 76.7% (95% CI: 71.7-81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3%; 95% CI: 34.6-46.1). CONCLUSIONS This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, sampled from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4-15 years.

中文翻译：

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澳大利亚儿童发烧的处理：基于人群的抽样调查。

背景技术儿童期的发烧是一种常见的急性表现，需要进行临床检查以鉴别出少数具有严重基础感染的儿童。已经制定了临床实践指南（CPG）以协助临床医生完成此任务。这项研究旨在评估根据CPG建议为澳大利亚儿童发烧管理提供的护理比例。方法从五种CPG中提取临床建议，并制定为47项临床指标，用于审核依从性。指标按护理阶段分类：评估，诊断和治疗。来自昆士兰州随机选择的卫生区的全科医师（GP），急诊科（ED）和医院入院的0至15岁儿童的患者记录。新南威尔士州和南澳大利亚州在2012年和2013年期间。经过培训以评估指标评估和遵守的资格的儿科护士，审查了合格的医疗记录。通过个体指标，护理阶段，年龄组和环境来评估依从性。结果现场团队对58名GP，34名ED和28名住院患者中的550名发烧儿童进行了708次就诊，进行了14879次合格指标评估。对于具有足够数据的33个指标，遵守率在14.7％至98.1％之间。估计与评估相关指标的依从性为51.3％（95％CI：48.1-54.6），诊断相关指标为77.5％（95％CI：65.3-87.1）和治疗为72.7％（95％CI：65.3-79.3）相关指标。3个月以下儿童的依从性为73.4％（95％CI：58.0-85.8）和64.7％（95％CI：57.0-71）。9）3-11个月大的儿童，两者均明显高于4-15岁的儿童（53.5％； 95％CI：50.0-56.9）。住院儿童的依从性护理比例为77.5％（95％CI：74.2-80.6）和住院儿童的76.7％（95％CI：71.7-81.3），均显着高于全科医生的儿童（ 40.3％； 95％CI：34.6-46.1）。结论本研究报告临床医生广泛遵循47项最佳方法来管理发热儿童，这些指标来自于60％的澳大利亚儿科人口的城市和农村地区。与患者评估有关的指标，全科医生环境中提供的护理以及4至15岁的儿童的文献记载依从性最低。住院儿童的依从性护理比例为77.5％（95％CI：74.2-80.6）和住院儿童的76.7％（95％CI：71.7-81.3），均显着高于全科医生的儿童（ 40.3％； 95％CI：34.6-46.1）。结论本研究报告临床医生广泛遵循47项最佳方法来管理发热儿童，这些指标来自于60％的澳大利亚儿科人口的城市和农村地区。与患者评估有关的指标，全科医生环境中提供的护理以及4至15岁的儿童的文献记载依从性最低。住院儿童的依从性护理比例为77.5％（95％CI：74.2-80.6）和住院儿童的76.7％（95％CI：71.7-81.3），均显着高于全科医生的儿童（ 40.3％； 95％CI：34.6-46.1）。结论本研究报告临床医生广泛遵循47项最佳方法来管理发热儿童，这些指标来自于60％的澳大利亚儿科人口的城市和农村地区。与患者评估有关的指标，全科医生环境中提供的护理以及4至15岁的儿童的文献记载依从性最低。结论本研究报告临床医生广泛遵循47项最佳方法来管理发热儿童，这些指标来自于60％的澳大利亚儿科人口的城市和农村地区。与患者评估有关的指标，全科医生环境中提供的护理以及4至15岁的儿童的文献记载依从性最低。结论本研究报告临床医生广泛遵循47项最佳方法来管理发热儿童，这些指标来自于60％的澳大利亚儿科人口的城市和农村地区。与患者评估有关的指标，全科医生环境中提供的护理以及4至15岁的儿童的文献记载依从性最低。