Indruk van de ouders
Vochtinname en plasluiers
Duur en beloop
Mogelijke focus (cutaan, neurologisch, pulmonaal, urologisch, etc)
Wat heerst er in de omgeving
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Temperatuur
Hydratie
Meningeale prikkeling
Ademhaling (frequentie, tirage, neusvleugelen, auscultatie)
KNO (farynx, trommelvliezen, etc)
Abdomen
Huid
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Bij afwezigheid van een focus: urineonderzoek
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Alarmtekens
Zieke indruk
BWZ-verlaging
Huilen (zwak, hoge toon)
Meningeale prikkeling
Blijvend braken
Petechiën
Bleekheid
Verminderde huidturgor
Neusvleugelen of intrekkingen
Verminderde capillary refill (> 3 sec)
Focale neurologische tekens of convulsies
Zeer hoog risico
Alarmtekens en
Koorts in eerste levensmaand
Koorts in eerste drie levensmaanden zonder focus
Hoog risico
Koorts in eerste drie levensmaanden met focus
Belaste voorgeschiedenis, niet-vaccinerende ouders, recent verblijf buitenland, etc
Kinderen met:
• Bleekheid
• Afwijkend gedrag (minder alert)
• Respiratoire problemen (tirage, neusvleugelen, etc)
• Tachycardie, verstoorde vochtbalans
• Aanhoudend hoge koorts > 5 dagen
Herbeoordeel (telefonisch) na een of twee dagen en bij dreigdende dehydratie na 4 uur
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Voorlichting:
Koorts is een gezonde reactie op een infectie
Koorts is geen goede indicator voor de ernst van de infectie
Koorts kan tot 10 dagen duren (doorgaans tot 4 dagen)
Beschrijf alarmtekens
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Paracetamol hoeft niet maar mag doorgaans wel
Geen antibiotica bij afwezigheid van bekende focus!
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15
Alarmtekens
Kinderen jonger dan 4 weken
Kinderen jonger dan 3 maanden zonder focus
Vermoeden ziekte van Kawasaki
Niet goed reageren op behandeling
Behoefte aan diagnostische zekerheid
Evaluation of Fever in Infants and Young Children. Am Fam Physician. 2013 Feb 15;87(4):254-260
NHG Standaard Kinderen met koorts
Van den Bruel A et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review Lancet. 2010 Mar 6;375(9717):834-45
Thompson M et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Health Technology Assessment, No. 16.15