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Which symptoms and clinical features correctly identify serious respiratory infection in children attending a paediatric assessment unit?
  1. C Blacklock1,
  2. R Mayon-White1,
  3. N Coad2,
  4. M Thompson1,3
  1. 1Department of Primary Health Care, University of Oxford, Oxford, UK
  2. 2Department of Paediatrics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  3. 3Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence toCL Blacklock, Department of Primary Health Care, Oxford University, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK; claire.blacklock{at}


Objective Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment.

Design Prospective diagnostic cohort study.

Setting Paediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust.

Patients 535 children aged between 3 months and 12 years with suspected acute infection.

Methods Parents completed a symptom questionnaire on arrival. Children were triaged by a nurse, who measured routine vital signs. The final diagnosis at discharge was used as the outcome. Symptoms and triage findings were analysed to identify features diagnostic of serious respiratory infection. Agreement between parent and triage nurse assessment was measured and kappa values calculated.

Results Parent-reported symptoms were poor indicators of serious respiratory infection (positive likelihood ratio (LR+) 0.56–1.93) and agreed poorly with nurse assessment (kappa 0.22–0.56). The best predictor was clinical assessment of respiratory distress (LR+ 5.04). Oxygen saturations <94% were highly specific (specificity 95.1%) but had poor sensitivity (35.6%). Tachypnoea (defined by current Advanced Paediatric Life Support standards) offered little discriminatory value.

Conclusion Parent-reported symptoms were unreliable discriminators of serious respiratory infection in children with suspected acute infection, and did not correlate well with nurse assessment. Using symptoms to identify higher risk children in this setting is unreliable. Nurse triage assessment of respiratory distress and some vital signs are important predictors.

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  • Funding This study was funded by the Medical Research Council as part of a programme grant in childhood infection in primary care (G0000340). The researchers were independent from the funders of the study. The study sponsors had no role in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The Department of Primary Health Care is part of the NIHR School of Primary Care Research.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Coventry Local Research Ethics Committee (04/Q2802/115).

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

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