SBI is Uncommon in the Absence of Paediatricians' Gut Feeling and Abnormal Respiratory Pattern

Overview

Journal Acta Paediatr

Specialty Pediatrics

Date 2022 Sep 17

PMID 36114734

Authors

Giorgio Cozzi

Antimo Tessitore

Manuela Giangreco

Paola Cogo

Elena Valentini

Simona Salis

Paola Pascolo

Egidio Barbi

Affiliations

Soon will be listed here.

Abstract

Aim: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI.

Methods: We designed a prospective, multicentre study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone.

Results: SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08-12.56; multivariate OR: 5.34, 95% CI: 2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98-7.40). Nevertheless, their associated sensitivity is low.

Conclusion: SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.

Citing Articles

SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.

Cozzi G, Tessitore A, Giangreco M, Cogo P, Valentini E, Salis S Acta Paediatr. 2022; 111(12):2362-2368.

PMID: 36114734 PMC: 9826455. DOI: 10.1111/apa.16544.

References

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Thompson M, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L . Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006; 367(9508):397-403. DOI: 10.1016/S0140-6736(06)67932-4. View

Lang H, Tasker R . Sepsis kills: suspect it, recognise it and be prompt with treatment. Arch Dis Child. 2016; 102(1):2-4. DOI: 10.1136/archdischild-2016-311418. View

Nigrovic L, Mahajan P, Blumberg S, Browne L, Linakis J, Ruddy R . The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants. Pediatrics. 2017; 140(1). PMC: 5495524. DOI: 10.1542/peds.2017-0695. View

Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens R . Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care. Health Technol Assess. 2012; 16(15):1-100. PMC: 4781278. DOI: 10.3310/hta16150. View

Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D . Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet. 2010; 375(9717):834-45. DOI: 10.1016/S0140-6736(09)62000-6. View

Goldstein B, Giroir B, Randolph A . International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(1):2-8. DOI: 10.1097/01.PCC.0000149131.72248.E6. View

Almond S, Mant D, Thompson M . Diagnostic safety-netting. Br J Gen Pract. 2009; 59(568):872-4. PMC: 2765844. DOI: 10.3399/bjgp09X472971. View

Van den Bruel A, Aertgeerts B, Bruyninckx R, Aerts M, Buntinx F . Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care. Br J Gen Pract. 2007; 57(540):538-46. PMC: 2099636. View

10.

Nijman R, Moll H, Smit F, Gervaix A, Weerkamp F, Vergouwe Y . C-reactive protein, procalcitonin and the lab-score for detecting serious bacterial infections in febrile children at the emergency department: a prospective observational study. Pediatr Infect Dis J. 2014; 33(11):e273-9. DOI: 10.1097/INF.0000000000000466. View

11.

Cozzi G, Tessitore A, Giangreco M, Cogo P, Valentini E, Salis S . SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern. Acta Paediatr. 2022; 111(12):2362-2368. PMC: 9826455. DOI: 10.1111/apa.16544. View

12.

Bang A, Chaturvedi P . Yale Observation Scale for prediction of bacteremia in febrile children. Indian J Pediatr. 2009; 76(6):599-604. DOI: 10.1007/s12098-009-0065-6. View

13.

Bachur R, Michelson K, Neuman M, Monuteaux M . Temperature-Adjusted Respiratory Rate for the Prediction of Childhood Pneumonia. Acad Pediatr. 2019; 19(5):542-548. DOI: 10.1016/j.acap.2018.11.015. View

14.

Leigh S, Robinson J, Yeung S, Coenen F, Carrol E, Niessen L . What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK. Arch Dis Child. 2020; 105(8):765-771. PMC: 7392496. DOI: 10.1136/archdischild-2019-318209. View

15.

Craig J, Williams G, Jones M, Codarini M, Macaskill P, Hayen A . The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010; 340:c1594. PMC: 2857748. DOI: 10.1136/bmj.c1594. View

16.

Pantell R, Newman T, Bernzweig J, Bergman D, Takayama J, Segal M . Management and outcomes of care of fever in early infancy. JAMA. 2004; 291(10):1203-12. DOI: 10.1001/jama.291.10.1203. View

17.

Van den Bruel A, Bartholomeeusen S, Aertgeerts B, Truyers C, Buntinx F . Serious infections in children: an incidence study in family practice. BMC Fam Pract. 2006; 7:23. PMC: 1435901. DOI: 10.1186/1471-2296-7-23. View

18.

Van den Bruel A, Thompson M, Buntinx F, Mant D . Clinicians' gut feeling about serious infections in children: observational study. BMJ. 2012; 345:e6144. PMC: 3458229. DOI: 10.1136/bmj.e6144. View

19.

Borensztajn D, Hagedoorn N, Carrol E, von Both U, Dewez J, Emonts M . A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children. Lancet Reg Health Eur. 2021; 8:100173. PMC: 8454797. DOI: 10.1016/j.lanepe.2021.100173. View

20.

Urbane U, Gaidule-Logina D, Gardovska D, Pavare J . Value of parental concern and clinician's gut feeling in recognition of serious bacterial infections: a prospective observational study. BMC Pediatr. 2019; 19(1):219. PMC: 6607523. DOI: 10.1186/s12887-019-1591-7. View