Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review

@article{Bruel2010DiagnosticVO,
  title={Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review},
  author={Ann Van den Bruel and Tanya Ali Haj-Hassan and Matthew Thompson and Frank Buntinx and David Mant},
  journal={The Lancet},
  year={2010},
  volume={375},
  pages={834-845}
}
View on Elsevier
doi.org
263 Citations
Highly Influential Citations
4
Background Citations
54
Methods Citations
8
Results Citations
6

Figures and Tables from this paper

263 Citations

Diagnostic value of laboratory tests in identifying serious infections in febrile children: systematic review
TLDR
Measuring inflammatory markers in an emergency department setting can be diagnostically useful, but clinicians should apply different cut-off values depending on whether they are trying to rule in or rule out serious infection.
Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review
Identifying a child with pneumonia in the large group of children with acute respiratory tract infections can be challenging for primary care physicians. Knowledge on the diagnostic value of specific…
Diagnosing serious infections in older adults presenting to ambulatory care: a systematic review.
TLDR
Few studies on the diagnostic accuracy of clinical features and blood tests to detect serious infections in older people presenting to ambulatory care are found, leading to substantial uncertainty.
Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care.
TLDR
Several clinical features are useful to increase or decrease the probability that a child has a serious infection, but none is sufficient on its own to substantially raise or lower the risk of serious infection.
Clinical Features for the Diagnosis of Pediatric Urinary Tract Infections: Systematic Review and Meta-Analysis
TLDR
Few clinical signs and symptoms are useful for diagnosing or ruling out urinary tract infection in children, and clinical prediction rules might be more accurate; however, they should be validated externally.
Predicting poor outcomes in children aged 1–12 with respiratory tract infections: A systematic review
TLDR
Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation and there was little evidence available to parents to identify children at risk of poor prognosis.
Risk score to stratify children with suspected serious bacterial infection: observational cohort study
TLDR
This study demonstrates the potential utility of a clinical score in risk stratifying children with suspected SBI and should incorporate it into a broader management algorithm including additional investigations to further stratify a child's risk.
Clinical presentation of childhood leukaemia: a systematic review and meta-analysis
TLDR
Over 50% of children with leukaemia have palpable livers, palpable spleens, pallor, fever or bruising on diagnosis, and common abdominal symptoms such as anorexia, weight loss, abdominal pain and abdominal distension are common.
Limited evidence for diagnosing bacterial skin infections in older adults in primary care: systematic review
TLDR
There is insufficient evidence to inform the diagnosis of bacterial skin infections in older adults in the community; clinicians should rely upon their clinical judgement and experience.
Limited Utility of SIRS Criteria for Identifying Serious Infections in Febrile Young Infants
TLDR
The performance of the SIRS criteria for predicting serious infections among febrile young infants was poor and logistic regression showed that male gender, body temperature ≥ 38.5 °C, heart rate ≥ 178 bpm, and age ≤ 50 days were significant predictors.
...
...

References

SHOWING 1-10 OF 58 REFERENCES
Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care.
TLDR
Some individual signs have high specificity and a serious infection can be excluded based on a limited number of signs and symptoms, and a multivariable triage instrument is created.
How well do vital signs identify children with serious infections in paediatric emergency care?
TLDR
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.
Efficacy of a Protocol to Distinguish Risk of Serious Bacterial Infection in the Outpatient Evaluation of Febrile Young Infants
TLDR
Managing UP infants as outpatients avoided 48 to 72 hours of hospitalization, decreasing health-care costs by an estimated total of $465,170, and had a sensitivity and negative predictive value for distinguishing SBI outcome.
[The young febrile child. Results of a multicenter survey].
  • Medicine
    Anales espanoles de pediatria
  • 2001
TLDR
The experience of the pediatrician supported by clinical and laboratory parameters are the most effective means of detecting febrile children (0-36 months) with potentially serious bacterial disease.
Observation, history, and physical examination in diagnosis of serious illnesses in febrile children ≤24 months*
Validity and reliability of clinical signs in the diagnosis of dehydration in children.
TLDR
Conventionally used clinical signs of dehydration are valid and reliable; however, individual findings lack sensitivity and should be based on the presence of at least three clinical findings.
A predictive model to estimate the risk of serious bacterial infections in febrile infants
TLDR
CRP, duration of fever, the “standardized clinical impression score”, a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis.
Observation, history, and physical examination in diagnosis of serious illnesses in febrile children less than or equal to 24 months.
TLDR
Assessment of appearance in a child with fever, when performed in a careful, integrated, stepwise fashion, improves the sensitivity of the history and physical examination in detecting serious illnesses in febrile children.
Prospective Evaluation of the Risk of Serious Bacterial Infection in Children Who Present to the Emergency Department With Hyperpyrexia (Temperature of 106°F or Higher)
TLDR
Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness, and no aspect of the clinical presentation reliably distinguishes between bacterial and viral illness.
A Score Identifying Serious Bacterial Infections in Children With Fever Without Source
TLDR
A simple clinical tool to identify serious bacterial infection in children with fever without a source and the sensitivity of the score for the identification of SBI was 94% and the specificity 81%.
...
...