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How well do vital signs identify children with serious infections in paediatric emergency care?
  1. M Thompson1,
  2. N Coad2,
  3. A Harnden1,
  4. R Mayon-White1,
  5. R Perera1,
  6. D Mant1
  1. 1
    Oxford University Department of Primary Health Care, Oxford, UK
  2. 2
    Department of Paediatrics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Dr Matthew Thompson, Oxford University Department of Primary Health Care, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK; matthew.thompson{at}dphpc.ox.ac.uk

Abstract

Objectives: To determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors.

Design: Prospective cohort of children presenting with suspected acute infection. We recorded vital signs, level of consciousness, activity level, respiratory distress, hydration and MTS category.

Setting: Paediatric assessment unit at a teaching hospital in England.

Participants: 700 children (median age 3 years), of whom 357 (51.0%) were referred from primary care, 198 (28.3%) self-referrals and 116 (16.6%) emergency ambulance transfers. Just over half (383 or 54.7%) were admitted.

Main outcome measures: Severity of infection categorised as serious, intermediate, minor or not infection.

Results: Children with serious or intermediate infections (n = 313) were significantly more likely than those with minor or no infection (n = 387) to have a temperature ⩾39°C, tachycardia, saturations ⩽94% or capillary refill time (CRT) >2 seconds. Having one or more of temperature ⩾39°C, saturations ⩽94%, tachycardia and tachypnoea was 80% (95% CI 75% to 85%) sensitive and 39% (95% CI 34% to 44%) specific for serious or intermediate infection. This was comparable to the MTS score (84% sensitive, 38% specific), and the NICE traffic light system (85% sensitive, 29% specific).

Conclusions: A combination of vital signs can be used to differentiate children with serious infections from those with less serious infections in a paediatric assessment unit and has comparable sensitivity to more complicated triage systems. The diagnostic value of combined vital signs and the NICE traffic light system remains to be determined in populations where the prevalence of severe illness is much lower.

https://doi.org/10.1136/adc.2009.159095

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    Footnotes

    • 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.

    • Competing interests None.

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

    • Ethics approval Ethics approval was obtained from Coventry Local Research Ethics Committee 04/Q2802/115.

    • Contributors MT conceived and designed the study, supervised data collection and data management, analysed and interpreted the data and drafted the article. He is guarantor for this article. NC contributed to study design, data collecting, interpretation of data and drafting of the article and critical revisions to the article. AH contributed to study design, interpretation of the data, drafting of the article and critical revisions to the article. RM-W was involved in design of the study, analysis and interpretation of data, drafting the article and critical revisions to drafts of the article. RP supervised the analysis and interpretation of the data, and provided critical revisions to the article. DM was involved in study design, interpretation of data and critical revisions to drafts of the article. All the authors contributed to drafts of the article, and revised commented on, and contributed to various drafts of the paper and read and approved the final draft.

    • ▸ Additional tables are published online only at http://adc.bmj.com/content/vol94/issue11