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fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last\u2009&gt;\u20091\u00a0year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), had an ED-Paediatric Early Warning Score of\u2009&gt;\u200915 (22 versus 12%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), or a C-reactive protein\u2009&gt;\u200960\u00a0mg\/l (aOR 1.4 (95%CI 1.3\u20131.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2\u20133.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1\u20132.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1\u20132.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8\u20137.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7\u20132.0), including sepsis\/meningitis (aOR 4.6, 95%CI 3.2\u20136.7). Children most at risk for sepsis\/meningitis were children with malignancy\/immunodeficiency (aOR 14.5, 8.5\u201324.8), while children with psychomotor delay\/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1\u20136.9) or PICU admission (aOR 9.7, 6.1\u201315.5).<\/jats:p><jats:p><jats:italic>Conclusions:<\/jats:italic> Our data show how children with comorbidities are a population at risk, as they more often are diagnosed with bacterial infections and more often require PICU admission and life-saving interventions.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 Children with comorbidities in general are more ill upon presentation than children without comorbidities.<\/jats:italic><jats:italic>\u2022 Children with comorbidities form a heterogeneous group; specific subgroups have an increased risk for invasive bacterial infections, while others have an increased risk of invasive interventions such as PICU admission, regardless of the cause of the fever.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04552-2","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T08:04:47Z","timestamp":1657181087000},"page":"3491-3500","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Febrile children with comorbidities at the emergency department \u2014 a multicentre observational study"],"prefix":"10.1007","volume":"181","author":[{"given":"Dorine M.","family":"Borensztajn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke N.","family":"Hagedoorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enitan D.","family":"Carrol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"von Both","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Emonts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"van der Flier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"de Groot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jethro","family":"Herberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benno","family":"Kohlmaier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Levin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian K.","family":"Maconochie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Martinon-Torres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruud G.","family":"Nijman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Pokorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Rivero-Calle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Tsolia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian J. 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MP reports a grant from Pfizer and financial support from Pfizer and Sanofi outside the submitted work. MF reports a grant from CSL Behring outside the submitted work. RN reports a grant from the National Institute for Health Research during the study conduct. ME reports financial support from the National Institute for Health Research Biomedical Research Centre based at Newcastle Hospitals NHS Foundation Trust and Newcastle University during the study conduct. MT is a member of the Advisory Board of MSD and Pfizer, a member of the National Committee on Immunization Practices, and a member of the national Scientific Advisory Group for the management of the pandemic. All other authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}