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

Abstract

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.

Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals’ Practices in France

“…In this national non-hospital-based cross-sectional prospective study, we report wide differences between current recommendations and observed practices of a large number of HPs (GPs, pediatricians and pharmacists) for the symptomatic management of fever in nearly 6,600 children. Contrary to recommendations [ 3 ] and as noted previously [ 30 , 31 ], temperature, a major vital sign, was recorded for only 40% of children during consultations with physicians. A least one drug was almost systematically (> 90%) prescribed by GPs and pediatricians and frequently advised by pharmacists for patients without a previous consultation (> 70%).…”

“…We were able to study various determinants of HPs’ practices related to parents, the child or the HPs themselves. As in other studies, the temperature was not systematically measured by physicians (40% vs. 25% to 54%) [ 30 , 31 ] and less often when parents had taken the temperature before the consultation and when this measurement was adequate (i.e., when parents measured the temperature with an electronic thermometer by a rectal, oral, auricular or axillary route). This situation may reflect a certain degree of confidence in the information provided by parents and a lack of time during busy consultations.…”

The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis

“…[ 33 ] Moreover, the inconsistent and non-standardized measurement of CRT in clinical practice may also reduce the potential utility of this vital sign. [ 34 , 35 ]…”

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

“…This is in agreement with a previous study that showed that overall documentation of vital signs by GPs is relatively poor in children presenting with acute infections. 12 …”