A retrospective cohort review study of patients with a primary immune deficiency who have presented to the paediatric emergency department with a fever.

Abstract

Aims: To identify, analyse, and synthesise retrospective data regarding the characteristics and risk factors that primary immune deficiencies (PIDs) inhibit to enhance patient outcomes and improve healthcare professional knowledge.

Background: There is currently limited research regarding the management of this high-risk paediatric cohort when they present to an emergency department (ED). This review analyses clinical data in the management, treatment and outcomes for these patients.

Design: This retrospective cohort review analysed patient characteristics, including the ED presentation and treatments, and hospital outcomes for children with a PID.

Method: Data from electronic medical records were extracted at a large tertiary paediatric hospital in South-East Queensland according to inclusion and exclusion criteria. Identified cases deidentified, analysed and reported. Baseline variables summarised using descriptive statistics.

Results: Out of 789 ED presentations relating either to fever or PID, 126 cases met the inclusion criteria. Overall, the length of time to be seen by a clinician in ED was a mean of 83 min, 27.8 % did not receive any treatment. Eleven patients had no investigations performed at all, of those who did, 5 % returned positive blood cultures. The immunology team were not consulted for 52 % of patients, and among those admitted, 70.3 % were classed as having a complex medical history.

Conclusions: There is limited consistency surrounding the management of children with a PID who present to the ED with a fever. Further research and resources are needed to facilitate enhanced emergency management to increase positive outcomes for this rare, but at-risk cohort of paediatric patients.