Diagnostic value of clinical features to identify serious childhood infection

January 01, 0001

Diagnostic value of clinical features to identify serious childhood infection

The aim of the researchers from Belgium and the UK was to identify which clinical features have value in confirming or excluding the possibility of serious infection in children presenting to ambulatory care settings in developed countries. In this systematic review, they searched electronic databases (Medline, Embase, DARE, CINAHL), reference lists of relevant studies, and contacted experts to identify articles assessing clinical features of serious infection in children. 1939 potentially relevant studies were identified. 30 studies were included in the analysis.

Cyanosis, rapid breathing, poor peripheral perfusion, and petechial rash were identified as red flags in several studies. Parental concern and clinician instinct were identified as strong red flags in one primary care study. Temperature of 40°C or more has value as a red flag in settings with a low prevalence of serious infection. No single clinical feature has rule-out value but some combinations can be used to exclude the possibility of serious infection—for example, pneumonia is very unlikely if the child is not short of breath and there is no parental concern.

The researchers concluded: "The red flags for serious infection that we identified should be used routinely, but serious illness will still be missed without effective use of precautionary measures. We now need to identify the level of risk at which clinical action should be taken."

Training in this area will become even more important with the rise of nurse practitioners. This is an interesting example in the change in clinical concerns with changing morbidity related to infectious diseases in developed countries. Also, this is about infections, not unwell children in general.

For the full abstract, click here.

The Lancet published online 3 February 2010
© 2010 Elsevier Ltd
Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Ann Van den Bruel, Tanya Haj-Hassan, Matthew Thompson, Frank Buntinx, David Mant, for the European Research Network on Recognising Serious Infection investigators. Correspondence to Dr Ann Van den Bruel: ann.vandenbruel@med.kuleuven.be

Category: PT. Professional Training Keywords: diagnostic, value, clinical features, serious infection, childhood, developed countries, systematic review, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 25 February 2010

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