How well do vital signs identify children with serious infections in paediatric emergency care?

• Published in: Archives of disease in childhood 2009-11, Vol.94 (11), p.888-893
• Main Authors: Thompson, M, Coad, N, Harnden, A, Mayon-White, R, Perera, R, Mant, D
• Format: Article
• Language: English
• Subjects: Acute Disease; Analysis; Bacterial infections; Biological and medical sciences; Cardiac arrhythmia; Child, Preschool; Children; Children & youth; Climate; Demographic aspects; Diagnosis; Diagnostic Tests; Diseases; Emergency medical care; Emergency medical services; Emergency Medical Services - methods; Emergency Service, Hospital; England; Error of Measurement; Ethnic Groups; Female; Fever; General aspects; Health risk assessment; Heart rate; Hospitals; Humans; Hydration; Infection; Infection - diagnosis; Infection - physiopathology; Infection in children; Infections; Length of stay; Male; Measurement Techniques; Medical sciences; Methods; Miscellaneous; Nurses; Pediatric diseases; Pediatric emergencies; Pediatrics; Pneumonia; Practice Guidelines as Topic; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Records (Forms); Risk factors; Sensitivity and Specificity; Severity of Illness Index; Statistical Analysis; Triage; Vital Signs
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2009.159095

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.