Of the 506 children enrolled in the prospective study, the triage questionnaire was filled out in 422 (83.4%) cases. The 422 children with a triage questionnaire did not differ from the 84 children without triage questionnaire regarding age, sex, residence, triage result, percentage non-native, and percentage referred by the GP to secondary care. Triage of the 422 children resulted in a consultation at the GP cooperative in 309 (73%) children (consultation group) and telephone advice in 113 (27%) children (advice group); no children were visited at home. The median age was 21 months (range 3–71 months). The number of male children was 242 (57%), and 214 children (51%) had non-native parents. There were 184 children aged <18 months and 283 were aged ≥18 months. The main characteristics of both age groups are listed in . The most common symptoms at triage were a running or blocked nose and cough (63–75%). Furthermore, the symptoms indicative of meningism and serious illness were frequently reported; crying during nappy change was reported in 48% of children aged <18 months. Drowsiness, restlessness, groaning, and a pale, ashen, or mottled skin was reported by the parents of about 40% to more than 50% of children. The frequencies of the triage answers, the alarm symptoms, and their univariate association with consultation and their univariate association with consultation as the outcome of triage, as odds ratios with 95% confidence intervals are listed in . In children aged <18 months, 14 of the 24 variables were significantly associated with consultation (P = 0.05), compared to 12 of 25 in children aged ≥18 months.
Characteristics of children with fever aged <18 months and ≥18 months.
Frequencies of triage answers and their univariate association with consultation as the outcome of triage.
The prognostic model for both age groups is presented in . Children aged <18 months whose parents reported that their child was drinking less than normal or was short of breath, were more likely to be invited for consultation. In children aged ≥18 months a duration of fever of ≥3 days, drowsiness, or a pale, ashen or mottled skin, was predictive for a consultation. The c value of the AUC was 0.73 for children aged <18 months, and 0.79 for children aged ≥18 months, indicating a good discriminative ability for consultation of both models.
Alarm symptoms predicting consultation as triage result in children aged <18 months and children aged ≥18 months in a multivariable logistic regression model.
In both age groups, the rate of consultation was not significantly different between children whose parents were non-native or native. However, the rate of consultations was higher in children whose parents were concerned according to the receptionist, compared to the children whose parents were not concerned. presents the observed and expected probability of a consultation in children with each predictive symptom or combination of symptoms, followed by the probability of a consultation in children with and in children without concerned parents. Children aged <18 months who did not drink less and were not short of breath were least likely to be seen by the GP (12 out of 28), but the probability of a consultation increased when their parents were concerned (six out of nine). When children had at least one of these symptoms, the additional value of concern of parents to the probability of a consultation was very small. Children aged ≥18 months who were not drowsy and did not have a pale, ashen, or mottled skin, and had a duration of fever <3 days, were least likely to be seen by the GP (13 out of 41), but the likelihood increased when their parents were concerned (7/11). This was also the case when children had a duration of fever ≥3 days, but were not drowsy and had no pale, ashen, or mottled skin. The additional value of parental concern for the probability of a consultation was negligible when children had a combination of these symptoms.
Predictive value of triage questions on consultation as triage result, and the additional value of concerned parents of febrile children.
Children with two or more of the alarm symptoms, were more likely to be referred to a pediatrician than those without alarm symptoms (0% versus 14% in children aged <18 months and 2% versus 12% in children aged ≥18 months).
The discriminative ability (χ2 value) of the model in children aged <18 months increased from 0.73 to 0.77, and in children aged ≥18 months from 0.79 to 0.83 when concern of parents was added.