The British Journal of General Practice vol:57 issue:540 pages:538-546
Background: Serious infections in children (sepsis, meningitis, pneumonia, pyelonnephritis, osteomyelitis, and cellulitis) are associates 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 the study: A prospective diagnostic accuracy study. Setting: Primary care in Belgium.Methos: 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 hospitalization was necessary). Accuracy was analyzed 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 ans symptoms was fairly low. Classical textbook signs (menigeal irritation impaired peripheral circulation) had high specificity. The primary classification tree consisted of five knots and had sensitivity of 96,8% (95% 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 tres 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.