{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:58:19Z","timestamp":1769158699383,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"EU\u2019s Horizon 2020 research and innovation programme","award":["668303"],"award-info":[{"award-number":["668303"]}]},{"name":"National Institute for Health Research Biomedical Research Centres at Imperial College London"},{"name":"Newcastle Hospitals NHS Foundation Trust"},{"DOI":"10.13039\/501100000774","name":"Newcastle University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000774","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NHS"},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003921","name":"Department of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003921","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Academic Clinical Fellowship award","award":["ACL-2018-21-007"],"award-info":[{"award-number":["ACL-2018-21-007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Discriminating viral from bacterial lower respiratory tract infections (LRTIs) in children is challenging thus commonly resulting in antibiotic overuse. The Feverkidstool, a validated clinical decision rule including clinical symptoms and C-reactive protein, safely reduced antibiotic use in children at low\/intermediate risk for bacterial LRTIs in a multicentre trial at emergency departments (EDs) in the Netherlands.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Using routine data from an observational study, we simulated the impact of the Feverkidstool on antibiotic prescriptions compared with observed antibiotic prescriptions in children with suspected LRTIs at 12 EDs in eight European countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We selected febrile children aged 1\u2009month to 5\u2009years with respiratory symptoms and excluded upper respiratory tract infections. Using the Feverkidstool, we calculated individual risks for bacterial LRTI retrospectively. We simulated antibiotic prescription rates under different scenarios: (1) applying effect estimates on antibiotic prescription from the trial; and (2) varying both usage (50%\u2013100%) and compliance (70%\u2013100%) with the Feverkidstool\u2019s advice to withhold antibiotics in children at low\/intermediate risk for bacterial LRTI (\u226410%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 4938 children, 4209 (85.2%) were at low\/intermediate risk for bacterial LRTI. Applying effect estimates from the trial, the Feverkidstool reduced antibiotic prescription from 33.5% to 24.1% [pooled risk difference: 9.4% (95% CI: 5.7%\u201313.1%)]. Simulating 50%\u2013100% usage with 90% compliance resulted in risk differences ranging from 8.3% to 15.8%. Our simulations suggest that antibiotic prescriptions would be reduced in EDs with high baseline antibiotic prescription rates or predominantly (&amp;gt;85%) low\/intermediate-risk children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Implementation of the Feverkidstool could reduce antibiotic prescriptions in children with suspected LRTIs in European EDs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkab023","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T20:13:58Z","timestamp":1611260038000},"page":"1349-1357","source":"Crossref","is-referenced-by-count":6,"title":["Impact of a clinical decision rule on antibiotic prescription for children with suspected lower respiratory tract infections presenting to European emergency departments: a simulation study based on routine data"],"prefix":"10.1093","volume":"76","author":[{"given":"Nienke N","family":"Hagedoorn","sequence":"first","affiliation":[{"name":"Department of General Paediatrics, Erasmus MC-Sophia Children\u2019s Hospital, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine H L","family":"Wagenaar","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Erasmus MC-Sophia Children\u2019s Hospital, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daan","family":"Nieboer","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bath","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Von Both","sequence":"additional","affiliation":[{"name":"Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University, Munich, Germany"},{"name":"Partner site Munich, German Center for Infection Research (DZIF), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enitan D","family":"Carrol","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences Global Health Liverpool, University of Liverpool, UK"},{"name":"Alder Hey Children\u2019s NHS Foundation Trust, Liverpool, UK"},{"name":"Liverpool Health Partners, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irini","family":"Eleftheriou","sequence":"additional","affiliation":[{"name":"Second Department of Paediatrics, National and Kapodistrian University of Athens, P. & A. Kyriakou Children\u2019s Hospital, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marieke","family":"Emonts","sequence":"additional","affiliation":[{"name":"Paediatric Immunology, Infectious Diseases & Allergy, Great North Children\u2019s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"},{"name":"Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK"},{"name":"NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel","family":"Van Der Flier","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands"},{"name":"Paediatric Infectious Diseases and Immunology, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"De Groot","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jethro","family":"Herberg","sequence":"additional","affiliation":[{"name":"Section of Paediatric Infectious Diseases, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benno","family":"Kohlmaier","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Medical University of Graz, Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Levin","sequence":"additional","affiliation":[{"name":"Section of Paediatric Infectious Diseases, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Lim","sequence":"additional","affiliation":[{"name":"Paediatric Immunology, Infectious Diseases & Allergy, Great North Children\u2019s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"},{"name":"Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK"},{"name":"NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Maconochie","sequence":"additional","affiliation":[{"name":"Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Martinon-Torres","sequence":"additional","affiliation":[{"name":"Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Cl\u00ednico Universitario de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruud","family":"Nijman","sequence":"additional","affiliation":[{"name":"Section of Paediatric Infectious Diseases, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Pokorn","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Rivero Calle","sequence":"additional","affiliation":[{"name":"Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Cl\u00ednico Universitario de Santiago de Compostela, Santiago de Compostela, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Tsolia","sequence":"additional","affiliation":[{"name":"Second Department of Paediatrics, National and Kapodistrian University of Athens, P. & A. 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