Better care for febrile children seen at out-of-hours services

Kool M, Elshout G, Bohnen AM, Koes BW, Berger MY. Better care for febrile children seen at out-of-hours services. Huisarts Wet 2016;59(11):474-7. Parents contact out-of-hours services relatively often because their child has a temperature and mention one or more alarm symptoms. The vast majority of these children have a non-serious infection and do not require further treatment. Children that appear to be seriously ill should be referred to secondary care. The Dutch Association of General Practitioners’ guideline ‘Children with fever’ recommends that children with only one alarm symptom be referred, but the majority of these referrals turn out to be a false alarm. General practitioners are relatively conservative in their referrals and score better in this respect than diagnostic algorithms, so it seems that they are guided by more than the alarm symptoms alone. It is more complex if GPs are uncertain about the seriousness of the illness. They often prescribe an antibiotic to reassure themselves and the parents, but this should be avoided because it gives a false sense of security. It would be better to clearly tell the parents when and where they should contact the service again. If the medical record is complete and unambiguous, the course of the disorder can be reviewed in the follow-up consultation, even if this occurs with a different GP.