Clinicians' gut feeling about serious infections in children: observational study

Bruel, Ann Van den; Thompson, Matthew; Buntinx, Frank; Mant, David

doi:10.1136/bmj.e6144

Cited by 153 publications

(209 citation statements)

References 24 publications

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“…The atypical features of UTIs included serious illness, raised serum creatinine levels, septicemia, high serum levels of C-reactive protein (≥ 8.0 mg/dL) and poor responses to suitable antibiotics (Mori et al 2007). Clinicians' gut feeling that infections in children are more serious than suggested by clinical assessment was also justified to perform VCUG ( Van den Bruel et al 2012).…”

Section: Methods and Subjectsmentioning

confidence: 99%

Voiding Cystourethrography Is Mandatory in Infants with Febrile Urinary Tract Infection

Kimata¹,

Kitao²,

Yamanouchi³

et al. 2013

Tohoku J. Exp. Med.

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Vesicoureteral reflux (VUR) is common condition in infants with febrile urinary tract infections (UTIs). Both VUR and febrile UTIs are risk factors for renal scars, characterized by glomerular hypertrophy with global or segmental sclerosis as cardinal features in pathology. Because renal scars may cause hypertension or chronic kidney diseases in later life, voiding cystourethrography (VCUG) has been mandatory for infants following their first febrile UTIs to identify VUR. However, increasing evidence suggests that the presence of VUR may not represent a direct risk factor for renal scars, which has led to an increase in the use of a stratified approach, in which VCUG is not performed for all patients. This study was conducted to verify whether the stratified approach is justified to identify infants at risk for renal scarring. The medical records of 306 infants with first febrile UTIs (median age, 4 months; 0-72 months) were reviewed. VUR was detected in 40.4% (67/166) of patients by the non-stratified approach, in which VCUG was performed in all patients. In contrast, VUR was identified in only 27.1% (38/140) of patients by the stratified approach, in which VCUG was performed only in the patients with high risk of developing renal scars. This difference in the discovery rate was significant (p = 0.02). Renal bladder ultrasonography had the sensitivities of as low as 45.7% and 52.9% in detecting VUR and in predicting renal scarring assessed by renal scintigraphy, respectively. In conclusion, VCUG should be performed in all infants after their first febrile UTIs.

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Section: Methods and Subjectsmentioning

confidence: 99%

Voiding Cystourethrography Is Mandatory in Infants with Febrile Urinary Tract Infection

Kimata¹,

Kitao²,

Yamanouchi³

et al. 2013

Tohoku J. Exp. Med.

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“…For example, the lack of emphasis on the value of parental perception and assessment presents a missed opportunity to empower parents that their gut feelings are a predictive feature in the assessment of childhood illness. 19,20 This has clear implications for the health system: inaccurate and inappropriate temperature measurement is likely to cause unnecessary parental anxiety and, consequently, drive contacts with healthcare services, risking overburdening health services, or, in contrast, might lead to delayed presentation when false-negative temperatures are noted and parents are falsely reassured.…”

mentioning

confidence: 99%

Assessing the appropriateness of information on childhood fever in thermometer package leaflets: a systematic audit of thermometers available in the UK

Hernandez¹,

Nicholson²,

Thompson³

2015

Br J Gen Pract

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BackgroundThermometers are found in most parents' homes, but little is known about the quality and accuracy of the information they provide, nor its consistency with current guidelines for managing fever. AimTo compare information included with commonly available thermometers with National Institute for Health and Care Excellence (NICE) guidance for management of feverish illness in children. Design and settingSystematic thermometer sampling from UK retailers between February 2013 and May 2013. MethodInformation was extracted from device packaging and leaflets on details and type of thermometer, instructions for use, normal ranges, and fever thresholds cited. This was compared with key parental recommendations from the 2013 NICE guidance on feverish illness in children. Associations were explored between cost of device and level of information. ResultsThere were 123 thermometers identified (ranging from £0.99 to £69.99), none of which made explicit reference to NICE guidance. Most (n = 81, 65.9%) recommended use at a body site consistent with NICE guidance, but only 17 (13.8%) defined fever using the correct threshold (≥38.0°C), and few (n = 12, 9.8%) included advice on fever management, of which four suggested actions not advised by NICE. There was no association between thermometer cost and provision of information consistent with NICE guidance. ConclusionParents and caregivers have access to a large number of thermometers, yet they lack evidence-based information about fever detection and management, and in some cases contain misleading information. This represents a missed opportunity to disseminate best practices from guidelines for management of fever in children, and thermometer manufacturers are urged to include information consistent with current guidance. Keywordsconsumer health information; general practice; thermometers.

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“…Data from primary care settings suggest that clinical and laboratory signs may be useful in the diagnosis of severe sepsis in developed countries [22, 23, 32 • , 33]. Clinicians' ''gut feelings'' (including a sense from the parents that this illness was ''different'') are also significant [34].…”

Section: Recognitionmentioning

confidence: 99%

What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts

Argent

2013

Curr Pediatr Rep

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While there has been a reduction in the number of children dying of septic shock in the richer countries of the world, septic shock remains an important cause of both mortality and morbidity for children across the world. Major reduction in the incidence of septic shock will depend on the implementation of public health measures, including immunization. Improvements in outcome of pediatric septic shock have been closely linked to early recognition (although this may be challenging in many situations); early antibiotic administration; early and appropriate fluid administration and subsequent escalation of critical care. A particular challenge has been the development and implementation of systems to ensure that these elements of management are reliably and efficiently implemented in children (even in well-resourced countries). Recent studies have highlighted the complexity of caring for patients with acute severe sepsis and septic shock in countries with fewer resources, and there is an urgent need for further studies to elucidate the implications of these studies for the management of children with septic shock, particularly in settings where additional critical care support such as inotropic or ventilator support may not be readily available.

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Clinicians' gut feeling about serious infections in children: observational study

Cited by 153 publications

References 24 publications

Voiding Cystourethrography Is Mandatory in Infants with Febrile Urinary Tract Infection

Voiding Cystourethrography Is Mandatory in Infants with Febrile Urinary Tract Infection

Assessing the appropriateness of information on childhood fever in thermometer package leaflets: a systematic audit of thermometers available in the UK

What’s New in the Recognition and Management of Septic Shock in Children: Dos and Don'ts

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