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Evaluation of temperature–pulse centile charts in identifying serious bacterial illness: observational cohort study
  1. Andrew J Brent1,2,
  2. Monica Lakhanpaul1,3,
  3. Nelly Ninis1,2,
  4. Michael Levin1,2,
  5. Roddy MacFaul1,4,
  6. Matthew Thompson1,5,6
  1. 1Royal College of Paediatrics & Child Health (RCPCH) Working Group on Recognising Acute Illness in Children, London, UK
  2. 2Department of Paediatrics, Imperial College London, London, UK
  3. 3Division of Paediatrics, Department of Medical Education and Social Care, University of Leicester
  4. 4Paediatric Department, Pinderfields Hospital, Wakefield, UK
  5. 5Oxford University Department of Primary Health Care, Institute of Health Sciences, Oxford, UK
  6. 6Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Andrew J Brent
    KEMRI-Wellcome Trust Research Programme, PO Box 230, 80108 Kilifi, Kenya; dr.a.brent{at}gmail.com

Abstract

Background Distinguishing serious bacterial infection (SBI) from milder/self-limiting infections is often difficult. Interpretation of vital signs is confounded by the effect of temperature on pulse and respiratory rate. Temperature–pulse centile charts have been proposed to improve the predictive value of pulse rate in the clinical assessment of children with suspected SBI.

Objectives To assess the utility of proposed temperature–pulse centile charts in the clinical assessment of children with suspected SBI.

Study design and participants The predictive value for SBI of temperature–pulse centile categories, pulse centile categories and Advanced Paediatric Life Support (APLS) defined tachycardia were compared among 1360 children aged 3 months to 10 years presenting with suspected infection to a hospital emergency department (ED) in England; and among 325 children who presented to hospitals in the UK with meningococcal disease.

Main outcome measure SBI.

Results Among children presenting to the ED, 55 (4.0%) had SBI. Pulse centile category, but not temperature–pulse centile category, was strongly associated with risk of SBI (p=0.0005 and 0.288, respectively). APLS defined tachycardia was also strongly associated with SBI (OR 2.90 (95% CI 1.60 to 5.26), p=0.0002). Among children with meningococcal disease, higher pulse and temperature–pulse centile categories were both associated with more severe disease (p=0.004 and 0.041, respectively).

Conclusions Increased pulse rate is an important predictor of SBI, supporting National Institute for Health and Clinical Excellence recommendations that pulse rate be routinely measured in the assessment of febrile children. Temperature–pulse centile charts performed more poorly than pulse alone in this study. Further studies are required to evaluate their utility in monitoring the clinical progress of sick children over time.

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Footnotes

  • Funding AJB is supported by a Wellcome Trust research training fellowship (081697). The authors wish to thank the Meningitis Research Foundation for their support for the meningococcal study, and the Well Child Medical Charity for their funding of the studies in Nottingham and for this study. Funding for the University of Oxford Department of Primary Health Care work on vital signs is provided by the NIHR programme grant ‘Development and implementation of new diagnostic processes and technologies in primary care.’

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the emergency department and meningococcal studies—granted by the Nottingham Research Ethics Committee and the South Thames Multi-Research Ethics Committee, respectively. The current analysis was also approved by the ethics committee of the London School of Hygiene and Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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