Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review

Bruel, Ann Van den; Haj-Hassan, T; Thompson, Matthew; Buntinx, Frank; Mant, David

doi:10.1016/s0140-6736(09)62000-6

Cited by 284 publications

(311 citation statements)

References 45 publications

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“…Even though there is strong evidence for the diagnostic value of parental concern and perceptions of illness, few thermometers mentioned this, and some dismissed it. 15 The threshold used to define fever is important to parents, as it is likely to be a factor in prompting actions such as antipyretic treatment at home or deciding to seek medical advice. However, only a small minority (13.8%) of leaflets recommended fever thresholds in line with NICE guidance.…”

Section: Relationship Between Cost and Quality Of Guidancementioning

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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Section: Relationship Between Cost and Quality Of Guidancementioning

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

Self Cite

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“…However at higher levels of prevalence, a negative test does not rule out infection with malaria parasites, and a positive test does not greatly increase the probability of malaria infection (which is already high). There is no clear threshold for applying a cut-off, but one commonly used rule is that a test is clinically useful to "rule in" or "rule out" a disease if the positive likelihood ratio is > = 5, or if the negative likelihood ratio is < = 0.2 respectively[13]. Applying this rule, a positive test ceases to be clinically useful at a prevalence of > 20% (see figure 3).…”

Section: Review Of the Evidence For The Assumptions Underlying Who's mentioning

confidence: 99%

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

Graz

Willcox

Szeless

et al. 2011

Malar J

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Recent WHO guidelines recommend a universal "test and treat" strategy for malaria, mainly by use of rapid diagnostic test (RDT) in all areas. The evidence for this approach is questioned here as there is a risk of over-reliance on parasitological diagnosis in high transmission situations, which still exist. In such areas, when a patient has fever or other malaria symptoms, the presence of Plasmodium spp neither reliably confirms malaria as the cause of the fever, nor excludes the possibility of other diseases. This is because the patient may be an asymptomatic carrier of malaria parasites and suffer from another disease.To allow clinicians to perform their work adequately, local epidemiologic data are necessary. One size does not fit all. If parasite prevalence in the population is low, a diagnostic test is relevant; if the prevalence is high, the test does not provide information of any clinical usefulness, as happens with any test in medicine when the prevalence of the tested characteristic is high in the healthy population. It should also be remembered that, if in some cases anti-malarials are prescribed to parasite-negative patients, this will not increase selection pressure for drug resistance, because the parasite is not there.In high transmission situations at least, other diagnoses should be sought in all patients, irrespective of the presence of malaria parasites. For this, clinical skills (but not necessarily physicians) are irreplaceable, in order to differentiate malaria from other causes of acute fever, such as benign viral infection or potentially dangerous conditions, which can all be present with the parasite co-existing only as a "commensal" or silent undesirable guest.

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“…It appears that the same 'red flag' signs used in identifying children with serious infection in developed countries bear remarkable, but not surprising, similarity to those promoted by the WHO and have been validated as useful, alongside good clinical acumen and careful regard of parental concerns. [14] In conclusion, this study suggests that the adapted ETAT tool correctly identifies many critically unwell children and differentiates those most likely to require admission from those likely to be able to go home. For the time being it is confirmed as an appropriate tool for our institution.…”

Section: Discussionmentioning

confidence: 57%

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

et al. 2012

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Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children's hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. The October 2007 series: 902 children aged 5 days -15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 -50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 -3.1). The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 -53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 -4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resourceconstrained countries and could be evaluated further in community emergency settings.

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Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review

Cited by 284 publications

References 45 publications

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

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

"Test and treat" or presumptive treatment for malaria in high transmission situations? A reflection on the latest WHO guidelines

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

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