Article Figures & Data
Figures
- Figure 1.
Flowchart of eligible children. GP, general practice.
Tables
Characteristics No. of Patients/Total No. of Patients Percentage Age: 3–6 months 35/443 7.9 6–12 months 87/443 19.6 >12 months 321/443 72.5 Male sex 247/443 55.8 Rectal temperature ≥38.0°C 135/419 32.2 Ill appearance 42/436 9.6 Duration of illness in days 1.00 (median) 0 to 43 (range) Variables Percentage Antibiotic Prescription Bivariate Analysis Multivariate Analysis If Characteristic Is Present If Characteristic Is Absent OR 95% CI P Value Selection OR 95% CI P Value Patient characteristics Age: 3–6 months NA NA 0.15 0.03–0.63 .01 EA 0.17 0.03–0.74 .03 6–12 months 0.71 0.41–1.23 .22 1.03 0.55–1.94 .93 >12 months (reference group) Concerned parents at home visit 36.1 (26/72) 25.1 (89/354) 1.70 0.99–2.91 .05 EA 2.02 1.06–3.58 .03 Number of children in household NA NA 1.25 1.00–1.56 .05 SS 1.16 0.90–1.48 .25 Patient history (signs present at moment of contacting out-of-hours service) Duration of illness at presentation (days) NA NA 1.08 1.02–1.14 .01 EA 1.05 0.99–1.12 .11 Fever in previous week 35.5 (22/62) 24.4 (73/299) 1.58 0.82–3.04 .17 EA 1.15 0.52–2.57 .73 Fever in past 6 months 29.6 (85/287) 20.3 (31/153) 1.67 1.04–2.66 .03 SS 1.33 0.78–2.26 .30 Vaccination in previous week 10.7 (3/28) 27.6 (114/413) 0.32 0.10–1.10 .07 SS 0.34 0.08–1.38 .13 Decreased urine production 35.7 (40/112) 22.6 (66/292) 1.84 1.16–2.91 <.01 SS 2.00 1.17–3.41 .01 Physical examination Tachypnea 19.1 (13/68) 27.4 (75/274) 0.71 0.36–1.40 .33 EA 0.84 0.41–1.75 .65 Height of rectal temperature NA NA 0.61 0.46–0.80 <.01 EA 0.52 0.37–0.71 <.01 Ill appearance 47.6 (20/42) 24.4 (96/394) 2.79 1.46–5.35 <.01 EA 3.26 1.30–8.20 .01 YOS score NA NA 1.08 0.99–1.18 .07 EA 1.02 0.91–1.15 .69 Earache resulting in altered behavioral or sleeping pattern 43.3 (13/30) 25.1 (95/378) 2.27 1.08–4.79 .03 SS 2.59 1.06–6.30 .04 Signs of throat infection 36.4 (40/110) 17.3 (38/220) 2.50 1.50–4.18 <.01 SS 2.37 1.35–4.15 <.01 Runny nose (patient history) 32.6 (46/141) 23.2 (69/297) 1.59 1.02–2.49 .04 SS 1.57 0.94–2.60 .08 Bold: multivariate P < .05. The physical examination forms included categorical variables with possible answers: “no, little, very, very much.” These variables were dichotomized using a cutoff point between “little” and “very.” Decreased urine production was considered if micturition was much decreased or if there was no micturition at all.
NA indicates not applicable; EA, expected association; SS, bivariate statistical significance; YOS, Yale Observation Scale.
- Table 3. Bivariate Analysis of Variables Not Included in the Multivariate Analysis of Antibiotic Prescription
Variables OR 95% CI Triage Concerned parents during triage 1.17 0.70–1.93 Physical examination Coughing 1.34 0.87–2.08 Runny nose 2.07 1.32–3.23 Drooling 1.33 0.79–2.23 Nasal flaring during breathing 1.11 0.12–10.64 Capillary refill >2 seconds 1.45 0.63–3.33 Abnormalities of the skin 0.74 0.45–1.22 Lymph nodes palpable in neck 0.95 0.61–1.48 Not able to get chin on chest 1.55 0.42–5.77 Patient history (signs present at moment of contacting out-of-hours service) Temperature measured at home before contacting the out-of-hours service 0.63 0.32–1.22 Child previously seen by own family physician 1.26 0.68–2.33 Out-of-hours service repeatedly contacted 0.84 0.38–1.83 Diarrhea 0.93 0.56–1.54 Vomiting 1.25 0.80–1.96 Drowsy/difficult to wake 1.41 0.92–2.16 Pale/gray/spotted skin 1.41 0.92–2.16 Skin rash 0.82 0.48–1.42 Fast breathing 1.44 0.93–2.23 Moaning 0.89 0.58–1.36 Febrile seizure 0.59 0.19–1.77 Problems during previous febrile episode 1.19 0.71–1.99 Preterm labor 0.81 0.45–1.46 Under treatment of a pediatrician 0.67 0.36–1.26 Under treatment of an ear, nose, and throat physician 1.33 0.56–3.16 Received all recommended vaccinations 1.49 0.41–5.37 Language barrier 1.44 0.67–3.07 Played as usual 0.80 0.51–1.23 Drinking less than half than normal 1.09 0.70–1.70 Cough 1.17 0.74–1.84 Restless/confused 0.99 0.62–1.58 Irritable/irritated 1.14 0.73–1.76 Drooling 0.95 0.55–1.65 Different illness than usual 1.21 0.78–1.88 Eye contact 1.10 0.60–2.03 Inconsolable crying 1.23 0.80–1.88 Crying by picking up 1.14 0.72–1.81 Demographic data Sex (if male) 1.27 0.83–1.95 Country of birth of mother, not Dutch 1.29 0.84–1.97 Country of birth of father, not Dutch 0.81 0.53–1.24 Education of mother: high 0.95 0.56–1.59 Education of father: high 1.10 0.69–1.76 Ethnicity of child according to parents, not Dutch 1.13 0.72–1.78 Income 1.08 0.92–1.26 Bold: P < .10. The history and physical examination forms included categorical variables with possible answers: “no, little, very, very much.” These variables were dichotomized using a cutoff point between “little” and “very.” Categorical variables with possible answers: “no, little, almost normal, normal” were dichotomized using a cutoff point between “no” and “little.” Diarrhea was characterized as reported diarrhea more than twice a day. Decreased urine production was considered if micturition was much decreased or if there was no micturition at all. Income was categorized before the analysis in net income per month: “<450,” “451 to 635,” “636 to 860,” “861 to 1135,” “1136 to 1600,” “1601 to 2270,” “>2270 Euro.”
CI, confidence interval; OR, odds ratio.
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