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Signs and symptoms in children with a serious infection: a qualitative study
Ann Van den Bruel1, Rudi Bruyninckx, Etienne Vermeire
1Department of General Practice, Katholieke Universiteit Leuven, Belgium. ann.vandenbruel@med.kuleuven.ac.be
Insights
Diagnosing serious infections in children is challenging. Behavioral changes like altered crying and parental concern are key early indicators, prompting further research into their diagnostic accuracy.
Area of Science:
- Pediatrics
- General Practice
- Infectious Diseases
Background:
- Early diagnosis of serious childhood infections is difficult in general practice due to low incidence and limited diagnostic tools.
- Current diagnostic methods rely on observation, clinical history, and physical examination, with limited understanding of key signs and symptoms.
- This study aimed to identify potentially new, important diagnostic variables for serious infections in children.
Purpose of the Study:
- To identify important diagnostic variables for serious infections in children presenting in general practice.
- To explore signs and symptoms related to or preceding the diagnosis of serious infections.
- To understand parental and physician perspectives on diagnostic indicators.
Main Methods:
- Qualitative study employing semi-structured interviews with parents and physicians.
- Grounded theory approach used for data analysis.
- Participants recruited from general practice and hospital settings, including 18 hospitalized children with serious infections.
Main Results:
- Changed behavior (drowsiness, irritability) and altered crying characteristics (moaning, inconsolable) were prominent signs.
- Parental opinion, noting differences from previous illnesses or critical incidents, was a significant indicator.
- Classical signs like fever were helpful when present but not reliable when absent.
Conclusions:
- Behavioral signs and symptoms are highly prominent in children with serious infections.
- These behavioral indicators warrant further assessment for diagnostic accuracy.
- A subsequent quantitative study is planned to validate these findings.
Background:
Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables.
Methods:
Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital.
Results:
18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent.
Conclusion:
behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.
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