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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/4038

Title: Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care
Authors: Van den Bruel, Ann
Aertgeerts, Bert
Bruyninckx, Rudi
Buntinx, Frank
Issue Date: 2007
Citation: BRITISH JOURNAL OF GENERAL PRACTICE, 57(540). p. 538-546
Abstract: Background Serious infections in children (sepsis, meningitis, pneumonia, pyelonephritis, osteomyelitis, and cellulitis) are associated with considerable mortality and morbidity. In children with an acute illness, the primary care physician uses signs and symptoms to assess the probability of a serious infection and decide on further management. Aim To analyse the diagnostic accuracy of signs and symptoms, and to create a multivariable triage instrument. Design of study A prospective diagnostic accuracy study. Setting Primary care in Belgium. Method Children aged 0-16 years with an acute illness for a maximum of 5 days were included consecutively. Signs and symptoms were recorded and compared to the final outcome of these children (a serious infection for which hospitalisation was necessary). Accuracy was analysed bivariably. Multivariable triage instruments were constructed using classification and regression tree (CART) analysis. Results A total of 3981 children were included in the study, of which 31 were admitted to hospital with a serious infection (0.78%). Accuracy of signs and symptoms was fairly low. Classical textbook signs (meningeal irritation impaired peripheral circulation) had high specificity. The primary classification tree consisted of five knots and had sensitivity of 96.8% (95% confidence interval [CI] = 83.3 to 99.9), specificity 88.5% (95% CI = 87.5 to 89.5), positive predictive value 6.2% (95% CI = 4.2 to 8.7), and negative predictive value 100.0% (95% CI = 99.8 to 100.0), by which a serious infection can be excluded in children testing negative on the tree. The sign paramount in all trees was the physician's statement 'something is wrong'. Conclusion Some individual signs have high specificity. A serious infection can be excluded based on a limited number of signs and symptoms.
Notes: Katholieke Univ Leuven, Acad Ctr Gen Practice, B-3000 Louvain, Belgium. Katholieke Univ Leuven, Belgian Ctr Evidence Based Med, Dept Gen Practice, CEBAM, Louvain, Belgium. Katholieke Univ Leuven, Dept Gen Practice, Louvain, Belgium. Univ Hasselt, Ctr Stat, Diepenbeek, Belgium. Univ Maastricht, Dept Gen Practice, Maastricht, Netherlands.Van den Bruel, A, Katholieke Univ Leuven, Acad Ctr Gen Practice, Kapucijnenvoer 33 Blok, B-3000 Louvain, Belgium.ann.vandenbruel@med.kuleuven.be
URI: http://hdl.handle.net/1942/4038
Link to publication: http://rcgp.publisher.ingentaconnect.com/content/rcgp/bjgp/2007/00000057/00000540/art00006
ISI #: 000248395800006
ISSN: 0960-1643
Category: A1
Type: Journal Contribution
Validation: ecoom, 2008
Appears in Collections: Research publications

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