What gives rise to clinician gut feeling, its influence on management decisions and its prognostic value for children with RTI in primary care: a prospective cohort study

Abstract

BackgroundThe objectives were to identify 1) the clinician and child characteristics associated with; 2) clinical management decisions following from, and; 3) the prognostic value of; a clinician’s ‘gut feeling something is wrong’ for children presenting to primary care with acute cough and respiratory tract infection (RTI).MethodsMulticentre prospective cohort study where 518 primary care clinicians across 244 general practices in England assessed 8394 children aged ≥3 months and < 16 years for acute cough and RTI. The main outcome measures were: Self-reported clinician ‘gut feeling’; clinician management decisions (antibiotic prescribing, referral for acute admission); and child’s prognosis (reconsultation with evidence of illness deterioration, hospital admission in the 30 days following recruitment).ResultsClinician years since qualification, parent reported symptoms (illness severity score ≥ 7/10, severe fever < 24 h, low energy, shortness of breath) and clinical examination findings (crackles/ crepitations on chest auscultation, recession, pallor, bronchial breathing, wheeze, temperature ≥ 37.8 °C, tachypnoea and inflamed pharynx) independently contributed towards a clinician ‘gut feeling that something was wrong’. ‘Gut feeling’ was independently associated with increased antibiotic prescribing and referral for secondary care assessment. After adjustment for other associated factors, gut feeling was not associated with reconsultations or hospital admissions.ConclusionsClinicians were more likely to report a gut feeling something is wrong, when they were more experienced or when children were more unwell. Gut feeling is independently and strongly associated with antibiotic prescribing and referral to secondary care, but not with two indicators of poor child health.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0716-7) contains supplementary material, which is available to authorized users.

The use of spectrograms improves the classification of wheezes and crackles in an educational setting

“…Chest auscultation is a widely used method in the diagnosis and follow up of several diseases. Health professionals use it to guide clinical decisions and treatment strategies 1 . However, the identification and interpretation of the sounds remains a subjective task.…”

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

“…Several studies were about the predictive value of gut feelings in the area of serious infection in children29; sepsis in primary care30; children with respiratory tract infection in general practice31; use of gestalt with regard to 32PE and the role of intuition in the suspicion of cancer 33 34. All these studies used a binary question ‘do you have gut feelings?’29–31 without using a proper definition of the concept. Therefore, it is unknown how the participants had interpreted the term ‘gut feelings’ or ‘intuition’?…”

Gut Feelings Questionnaire in daily practice: a feasibility study using a mixed-methods approach in three European countries

“…For instance, Turnbull et al used in their questionnaire ‘my GF is ‘something is wrong’: yes or no, whereas GFs were explained in the instruction booklet as ‘GF that the child’s illness may be more serious than is superficially apparent’. 6 Several other studies measuring GFs do miss a detailed and accurate definition of the sense of alarm. 4 5 In a study regarding the recognition of sepsis in primary care, 5 the authors did not give details of the concept or definition to which they were referring when using the expression ‘GF’.…”

“…Experienced GPs were more likely to report having a GF. 6 The GFQ is a useful tool for eliciting reflection on diagnostic processes between experienced GPs and trainees.…”