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Because a newly available point-of-care test may have real interest especially for children in the Emergency Department (ED) setting, by limiting painful and stressful venipunctures and decreasing the length of stay in the ED, the investigators hypothesize that integrating this new capillary Procalcitonin (PCT) rapid test in the DIAFEVER CPR (Clinical Prediction Rules) could represent a highly valuable diagnostic tool to identify a group with low Invasive Bacterial Infection (IBI) risk and could limit unnecessary exams and antibiotic prescriptions. The aim of this present study is to demonstrate the impact of this new PCT rapid-test-based CPR on antibiotic prescription rate in young children with Fever Without Source (FWS) presenting to the ED and on morbidity and mortality
This prospective multicentric randomized study will include 5000 febrile children aged six days to three years, diagnosed with fever without source, in 26 participating French and Swiss emergency departments, during a 36-month period.
During one period, all children will receive usual care. In a second period, the DIAFEVER algorithm will be applied in half of the clusters, and in the remaining clusters, children will still receive usual care.
Then in the last period of one year, all centers will apply the new PCT-based algorithm.
At day 15 after the first consultation, data concerning death, intensive care unit admission, disease-specific complications, diagnosis of bacterial infections and proportion of antibiotic treatments will be assessed by questioning parents by use of an online electronic case report form or a phone call. The endpoints will be compared between the two groups by using a mixed logistic regression model adjusted on clustering of participants within centers and period within centers.
To perform complementary studies, a biocollection will be proposed to parents when blood tests will be indicated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual care | No Intervention | Local usual management of FWS (pragmatic approach) | |
| DIAFEVER algorithm | Experimental | New DIAFEVER sequential algorithm PCT rapid test-based will be applied |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DIAFEVER algorithm | Diagnostic Test | PCT rapid test-based predictive algorithm |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in antibiotics exposure | Related to the superiority objective : change in antibiotics exposure based on the proportion of children who received ABT | at day 15 after the first ED consultation |
| Measure | Description | Time Frame |
|---|---|---|
| Description of the current epidemiology of FWS among children < 36 months old admitted in an ED | The incidence of FWS among children admitted in EDs, the incidence of Severe Bacterial Infection (SBI) and IBI among the children admitted in the ED with FWS | At inclusion visit |
| Diagnostic value of the DIAFEVER prediction rule for SBI and IBI diagnosis |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital | Angers | France | ||||
| University Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41407517 | Derived | Malorey D, Tavernier E, Drouard A, Vrignaud B, Bailhache M, Guyon G, Titomanlio L, Brehin C, Abalea L, Gervaix A, Basmaci R, Dubos F, Tran A, Desgranges M, Launay E, Gras-Leguen C; Diafever Study Group. Point-of-care decision rule for antibiotic prescriptions in young children with fever without source: an open cluster randomised trial. Arch Dis Child. 2026 Mar 17:archdischild-2025-329438. doi: 10.1136/archdischild-2025-329438. Online ahead of print. | |
| 32792425 |
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This is an open cluster randomized clinical trial with random and sequential crossover of clusters from control to intervention until all clusters are exposed. Clusters are defined as EDs.
2 periods will be considered, one when all children will receive usual care, whatever the cluster, and a second one when, in half of the clusters, the DIAFEVER algorithm will be applied, and in the remaining clusters, children will still receive usual care.
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Assessment of sensitivity, specificity, predictive values, Likelihood Ratio, of the DIAFEVER prediction rule (combining high- and intermediate-risk versus low-risk populations) considering the SBI/IBI diagnosis as the gold standard |
| At inclusion visit |
| Impact of the DIAFEVER prediction rule on median length of stay in the ED | at day 15 after the first ED consultation |
| Impact of the DIAFEVER prediction rule on the proportion of children with laboratory tests prescription | at day 15 after the first ED consultation |
| Impact of the DIAFEVER prediction rule on hospitalization rates | at day 15 after the first ED consultation |
| vaccine coverage of children consulting for FWS evaluated by the vaccination coverage rate (among children with FWS) | at day 15 after the first ED consultation |
| theoretically vaccine-preventable SBI | theoretically vaccine-preventable SBI is defined as an infection with an identified serotype included in the national vaccine schedule and occurring in a child with untimely vaccination | at day 15 after the first ED consultation |
| morbidity and mortality | Morbidity and mortality based on a binary composite outcome considering occurrence or not during the 15 days after discharge from the ED of one of the following events:
| at day 15 after the first ED consultation |
| Bordeaux |
| France |
| University Hospital | Brest | France |
| University Hospital | Caen | France |
| AP-HP Antoine Béclère | Clamart | France |
| University Hospital | Clermont-Ferrand | France |
| Hopital Louis Mourier | Colombes | France |
| Centre Hospitalier Intercommunal | Créteil | France |
| University Hospital | Grenoble | France |
| CHD Vendée | La Roche-sur-Yon | France |
| Regional University Hospital | Lille | France |
| Saint Antoine Saint Vincent Hospital | Lille | France |
| Southern Bretagne Hospital | Lorient | France |
| Hospices civils de Lyon | Lyon | France |
| University Hospital | Montpellier | France |
| Regional University Hospital | Nancy | France |
| University Hospital | Nice | France |
| AP-HP Necker-Enfants Malades | Paris | France |
| AP-HP Robert Debré | Paris | France |
| Regional University Hospital | Rennes | France |
| CHU | Rouen | France |
| Saint Brieuc Hospital | Saint-Brieuc | France |
| Chu Saint Etienne | Saint-Etienne | France |
| University Hospital | Strasbourg | France |
| University Hospital | Toulouse | France |
| Hopital des Enfants | Geneva | Switzerland |
| Derived |
| Hubert G, Launay E, Feildel Fournial C, Chauvire-Drouard A, Lorton F, Tavernier E, Giraudeau B, Gras Le Guen C. Assessment of the impact of a new sequential approach to antimicrobial use in young febrile children in the emergency department (DIAFEVERCHILD): a French prospective multicentric controlled, open, cluster-randomised, parallel-group study protocol. BMJ Open. 2020 Aug 13;10(8):e034828. doi: 10.1136/bmjopen-2019-034828. |
| ID | Term |
|---|---|
| D008581 | Meningitis |
| D014552 | Urinary Tract Infections |
| ID | Term |
|---|---|
| D000090862 | Neuroinflammatory Diseases |
| D009422 | Nervous System Diseases |
| D007239 | Infections |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
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