[Healthcare for teenagers: are we working together?].

There are about 1.8 million children between 10 and 18 years of age in the Netherlands in 2016. These teenagers account for approximately 10% of the total population.

[Rare disease: centre of expertise or care guideline?].

In the Netherlands, recommendations for managing rare diseases are developed by multidisciplinary teams working together in centres of expertise who form the core of the health care system for these patients. This is an excellent option, in which also transition from care for children to care for adults can be warranted. However, in a very rare and complex disease where the patient group consists of only a few patients, centres of expertise will not be established.

Validating and updating a prediction rule for serious bacterial infection in patients with fever without source.

Aim: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.

Methods: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis.

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics.

Background: Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research.

Application of a diagnostic decision rule in children with meningeal signs: a cost-minimization study.

Objectives: Recently, we developed a diagnostic rule for the diagnosis and treatment of children with meningeal signs. This rule may provide the physician with a rationale to decide on the use of diagnostic and treatment procedures in these children and to improve their care. In this study, we estimated cost savings of the rule compared with current practice.

External validation is necessary in prediction research: a clinical example.

Background And Objectives: Prediction models tend to perform better on data on which the model was constructed than on new data. This difference in performance is an indication of the optimism in the apparent performance in the derivation set. For internal model validation, bootstrapping methods are recommended to provide bias-corrected estimates of model performance.

[A diagnostic decision rule for managing children with signs of meningeal irritation].

Objective: To develop a diagnostic decision rule based on clinical features to predict the risk of bacterial meningitis in children with signs of meningeal irritation.

Design: Retrospective and prospective.

Method: Predictors for bacterial meningitis were identified by collecting clinical data from the records of 360 patients (aged 1 month to 15 years) who consulted the Casualty Department, Sophia Children's Hospital, Rotterdam, the Netherlands, with signs of meningeal irritation during the period 1988-1998.

Cost-utility analysis of patient care in children with meningeal signs.

Objectives: We designed a model of diagnostic and therapeutic interventions applied in children with meningeal signs. Using this model, we determined in a cost-utility analysis the consequences for society of different diagnostic strategies in terms of quality-adjusted life-years (QALYs) and costs.

Methods: Data were used from 360 children (0.

Early prediction of neurological sequelae or death after bacterial meningitis.

Unlabelled: This study determined independent predictors of the occurrence of permanent neurological sequelae or death after childhood bacterial meningitis. Data were used from a large study on children (aged 1 mo to 15 y) initially presenting with meningeal irritation. A nested case-control study was performed on children with (n = 23) and without (n = 70) permanent neurological sequelae (hearing impairment, locomotor dysfunction, mental retardation or epilepsy) or death after bacterial meningitis.

Predicting serious bacterial infection in young children with fever without apparent source.

Unlabelled: The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1-36 mo who attended the paediatric emergency department because of fever without source (temperature > or = 38 degrees C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis.

[Diagnostic image (59); corrected placement. Accidental ingestion of alcohol 70% mistaken for very similarly packaged fennel water].

In one week two separate cases of accidental ethanol 70% ingestion by a sibling were seen, due to the similar appearance of the flask with commercially obtainable fennel water (a herbal preparation).

[Diagnostic image (59). Accidental ingestion of 70% alcohol mistaken for very similarly packaged fennel water].

In one week two separate cases of accidental ethanol 70% ingestion by a sibling were seen, due to the similar appearance of the flask with commercially obtainable fennel water (a herbal preparation).

Signs of meningeal irritation at the emergency department: how often bacterial meningitis?

Objective: Although signs of meningeal irritation are highly indicative of meningitis, they are not pathognomonic. In this study, we described the final diagnoses in children with signs of meningeal irritation, and we assessed the frequency of bacterial meningitis related to specific signs of meningeal irritation.

Methods: Information was collected from records of 326 patients (aged 1 month to 15 years) who visited the emergency department of the Sophia Children's Hospital between 1988 and 1998 with signs of meningeal irritation, assessed by either the general practitioner or the pediatrician.

Parents' fear regarding fever and febrile seizures.

In order to improve the effectiveness of information, we studied parents' perceptions and knowledge about fever and febrile seizures. A questionnaire study was carried out among the parents whose children (n = 230) participated in a randomized controlled trial of ibuprofen to prevent recurrent febrile seizures. Of the 230 parents, 181 (79%) responded to the questionnaire.

Characteristics of the initial seizure in familial febrile seizures.

Complex seizure characteristics in patients with a positive family history were studied to define familial phenotype subgroups of febrile seizures. A total of 51 children with one or more affected first degree relatives and 177 without an affected first degree relative were compared for history of complex characteristics of the initial febrile seizure. No difference was found in the frequency of febrile status epilepticus (OR = 1.

Frequency of fever episodes related to febrile seizure recurrence.

The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied.

Temperature, age, and recurrence of febrile seizure.

Objective: Prediction of a recurrent febrile seizure during subsequent episodes of fever.

Design: Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen syrup to prevent febrile seizure recurrences.

Setting: Two pediatric hospitals in the Netherlands.

Informed consent, parental awareness, and reasons for participating in a randomised controlled study.

Background: The informed consent procedure plays a central role in randomised controlled trials but has only been explored in a few studies on children.

Aim: To assess the quality of the informed consent process in a paediatric setting.

Methods: A questionnaire was sent to parents who volunteered their child (230 children) for a randomised, double blind, placebo controlled trial of ibuprofen syrup to prevent recurrent febrile seizures.

Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences.

Objectives: Febrile seizures recur frequently. Factors increasing the risk of febrile seizure recurrence include young age at onset, family history of febrile seizures, previous recurrent febrile seizures, time lapse since previous seizure <6 months, relative low temperature at the initial seizure, multiple type initial seizure, and frequent febrile illnesses. Prevention of seizure recurrences serves two useful purposes: meeting parental fear of recurrent febrile seizures in general and reducing the (small) risk of a long-lasting and eventually injurious recurrent seizure.

The duration of febrile seizures and peripheral leukocytosis.

In 203 consecutive children with febrile seizures, no clear association (odds ratio = 1.0 [95% CI, 0.9-1.

Seizures associated with fever: clinical data as predictors for normal biochemical blood levels.

Unlabelled: We developed a predictive model to assess the probability of normal biochemical blood test results in children presenting with a seizure associated with fever. The models were based on various combinations of patient characteristics of the history and physical examination of 203 children. The characteristics included gender, age in years, previous history of febrile seizures, family history of febrile seizures, fever previous to the seizure, vomiting and diarrhoea previous to the seizure.

Prediction of febrile seizures in siblings: a practical approach.

Unlabelled: To quantify the risk of febrile seizures (FS) in relatives of children with FS and to predict the risk of FS in siblings, we calculated cumulative risks of FS in first degree relatives of 129 children with FS. The study was conducted as a prospective follow up study of FS recurrences at the outpatient clinic of the Sophia Children's Hospital in Rotterdam. Thirteen parents and 12 siblings had experienced FS, accounting for a 6-year cumulative risk of 7%.

A predictive model to estimate the risk of serious bacterial infections in febrile infants.

Unlabelled: Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%-20% have an SBI.