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  • Title: Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care.
    Author: de Vos-Kerkhof E, Geurts DH, Wiggers M, Moll HA, Oostenbrink R.
    Journal: Arch Dis Child; 2016 Feb; 101(2):131-9. PubMed ID: 26163122.
    Abstract:
    CONTEXT: Follow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician. OBJECTIVE: To systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits. DATA SOURCES: MEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed. STUDY SELECTION: Studies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation). DATA EXTRACTION: Two reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence. RESULTS: We summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians' characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits. CONCLUSIONS: Within the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.
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