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Diagnosis: clinician's gut feeling helps detect children with serious infection

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Questions: In children with acute illness (patient) does gut feeling (test) rule in or rule out serious infections (outcome)?

Methods

Design: Prospective cohort study of children 0–16 years.

Setting: Primary care, general practitioners or community paediatricians. Flanders, Belgium.

Patients The study included 3890 children aged 0–16 years, presenting with an acute illness of less than 5 days duration.

Diagnostic strategy At the initial consultation the following were recorded:

  1. A list of clinical features was made, on which an objective clinical impression was based.

  2. The clinician also recorded their gut feeling, defined as an intuitive feeling that something was wrong even if the clinician was unsure why.

Subsequently a panel, blinded to the initial clinical evaluation, made the final diagnosis of serious infection, based on hospital records and clinicians’ follow-up information. Association of gut feeling with specific clinical features or with clinician experience was analysed using logistic regression.

Outcomes Of 3890 children, …

Correspondence to Dr Ian D Wacogne, General Paediatrics, Birmingham Childrens Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; ian.wacogne{at}bch.nhs.uk

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