Clinicians' overestimation of febrile XXXX risk assessment.

@entity1 @entity341 @entity2348 @entity221 @entity1851
We aimed to estimate clinicians' based risk thresholds at which febrile @entity1 would be managed as @entity2348 ( @entity2348 ) to determine influencing characteristics and to compare thresholds with prediction model (Feverkidstool) risk estimates. Twenty-one video vignettes of febrile @entity1 visiting the @entity341 ( @entity341 ) were assessed by 42 (40.4  %) international paediatricians/paediatric emergency clinicians. Questions were related to clinical risk scores of the @entity1 having @entity2348 and @entity2348 management decisions on visual analogue scales. Feverkidstool risk scores were based on clinical signs/symptoms and @entity1851 . Amongst vignettes assigned to @entity2348 management, the median risk was 60  % (interquartile range (IQR) 30.0-80.5) and 16.0  % (IQR 5.0-32.0) when vignettes were not managed as @entity2348 . Ill appearance and aberrant circulatory signs were the most influencing factors, as age and duration of @entity221 were the least influencing factors on @entity2348 management decisions. Feverkidstool risk scores varied from 13  % (IQR 7.7-28.1) for @entity2348 management to 7.3  % (IQR 5.7-16.3) for no @entity2348 management. CONCLUSION: Clinicians assigned high risk scores to @entity1 who they would have managed as @entity2348 , mostly influenced by ill appearance and aberrant circulation. In contrast to @entity2348 risk assessment of the Feverkidstool, clinicians' appeared to apply a more stepwise assessment of the risk of presence/absence of @entity2348 at different steps in the diagnostic and therapeutic process. Uniform risk thresholds at which one should start @entity2348 management in febrile @entity1 remains unclear; risk thresholds at which we refrained from @entity2348 management were more consistent. WHAT IS KNOWN:    Only a small proportion of febrile @entity1 presenting to the @entity341 will have @entity2348 ( @entity2348 ) and uniform risk thresholds to start or withhold @entity2348 treatment are not known.    The low prevalence of @entity2348 and consequently the low exposure of clinicians to these infections make them rely more on alarming signs or clinical decision rules. What is New:    Previously identified model predictors for @entity2348 appeared to be significantly influencing factors in clinicians' febrile @entity1 management in emergency care.    Clinicians' wielded higher risk thresholds regarding @entity2348 febrile @entity1 management than reflected by the clinical prediction model while smaller differences in risk thresholds between clinical and model prediction  were observed  when clinicians refrained   from @entity2348 management.
