Use of thermometers in general practice.

Clarke, S.

doi:10.1136/bmj.304.6832.961

Cited by 21 publications

(5 citation statements)

References 12 publications

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“…8 Self-reported thermometer use was also studied among a group of 116 GPs, and found that more than half of the GPs reported that they used a thermometer up to only a dozen times over a 6-month period, or not at all. 12 A baseline audit of triage recording of vital signs in children <6 years of age in an emergency department setting in 2007 showed higher levels of recording than in this study. 13 However even in this emergency setting, vital signs were recorded in variable proportions of children (temperature was recorded in 65%, pulse in 53%, RR in 31% and CRT in 13% of 106 children).…”

Section: Comparison With Other Studiesmentioning

confidence: 39%

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

2012

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Background NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently. AimTo identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care. Design and settingObservational study in 15 general practice surgeries in Oxfordshire and Somerset, UK. MethodA standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection. ResultsOf the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations. ConclusionGPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections.

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Section: Comparison With Other Studiesmentioning

confidence: 39%

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

2012

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“…Many mothers and doctors estimate children's temperature by touch 2. We assessed whether mothers and medical students could use touch to determine if children had fever.…”

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confidence: 99%

Diagnosing fever by touch: observational study

Whybrew

Murray

Morley

1998

BMJ

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2 We assessed whether mothers and medical students could use touch to determine if children had fever. Subjects, methods, and resultsDuring their elective in a Zambian hospital, medical students and the child's mother felt children's abdomen, forehead, and neck and independently recorded whether the child felt hot. Simultaneously, a mercury thermometer was used to measure axillary temperature for exactly 3 minutes. Rectal temperature measurement was not permitted at this hospital.In total, 1090 children aged 1 month to 16 years (median 2 years) were studied. The mean ambient temperature was 24.5 (SD 2.0)°C; the mean axillary temperature from 24 children not recently vaccinated and with no complaint was 36.7 (2SD 1.12)°C. Therefore 37.8°C or higher was defined as a fever. With this definition, 236 (27%) children had fever.The mothers assessed 862 children and thought 574 (67%) were warm or hot. Their sensitivity was 94% (221/236), specificity 44% (273/626), positive predictive value 39% (221/574), and negative predictive value 95% (273/288).Two students assessed 1086 children and thought 525 (48%) were warm or hot. Their sensitivity was 94% (257/274), specificity 67% (544/812), positive predictive value 49% (257/525), and negative predictive value 97% (544/561). Two students, working independently, had remarkably similar results (sensitivities 95% and 94%, positive predictive values 50% and 47%). The table shows the data for the two groups. CommentThis study showed that when mothers and medical students felt the children they rarely missed a child with fever, but they overestimated the number who had fever.Because it was impractical to measure rectal temperature for cultural reasons, axillary temperature had to be used. Axillary temperature is not always accurate. One study comparing axillary and rectal temperature found means of 36.8°C and 37.4°C, respectively, and a median difference of 0.5°C (range − 1.0°C to 3.2°C).3 The difference was largest in children with high fever. The shortcomings of axillary temperature measurement might have influenced our results: positive predictive values might have been higher if rectal temperature been used. These children felt warmer than did children in Britain, possibly because of the higher ambient temperature and the tendency to overdress. Therefore, rather than use a range derived from a different population, we calculated a normal range for the group. Defining fever as a temperature of 37.8°C or more was higher than the temperature used in other studies (37.2°C, 3 37.4°C, 4 and 37. 5°C 5 ). In our study the thermometer was assiduously kept in the axilla for 3 minutes. In other studies the temperature was taken for a shorter time, which may account for the lower temperatures used.A recent African study investigated the ability of patients (1606 men and children) or their carers to decide whether they had a fever.5 Twenty per cent had fever, but only 28% of those thought to have fever did; of those thought to have a normal temperature, 92% did.These two studies establi...

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“…In 1992, a survey of thermometer use reported that 48% of GPs measured temperature less than once per fortnight. 10 Despite the paucity of evidence, the National Institute for Health and Clinical Excellence (NICE) has recommended that temperature, heart rate, respiratory rate, and capillary refill time are measured in all children presenting to primary care with febrile illness. 11 This study surveyed how GPs measure and use vital signs in pre-school children presenting with acute infections, and compared their utility with the clinical features used to assess a child's respiratory status and their overall severity of illness.…”

Section: Introductionmentioning

confidence: 99%

Using vital signs to assess children with acute infections: a survey of current practice

et al. 2008

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GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known. AimTo describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections. Design of studyQuestionnaire survey. SettingAll 210 GP principals working within a 10 mile radius of Oxford, UK. MethodData were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness. ResultsOne hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness. ConclusionVital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.

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Use of thermometers in general practice.

Abstract: Objective-To identify the attitudes of general practitioners towards the use of thermometers in general practice.

Cited by 21 publications

References 12 publications

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

When and how do GPs record vital signs in children with acute infections? A cross-sectional study

Diagnosing fever by touch: observational study

Using vital signs to assess children with acute infections: a survey of current practice

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