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Using vital signs to assess children with acute infections: a survey of current practice
Matthew Thompson1, Richard Mayon-White, Anthony Harnden
1Oxford University Department of Primary Health Care, Old Road Campus, Oxford, UK. matthew.thompson@dphpc.ox.ac.uk
Insights
General practitioners (GPs) rarely measure vital signs in children with acute infections. Clinical observation is more valued than vital signs for assessing illness severity in pediatric care.
Area of Science:
- Pediatric Medicine
- General Practice
- Clinical Assessment
Background:
- General practitioners (GPs) are advised to measure vital signs in children with acute infections.
- The added benefit of vital sign measurement beyond overall clinical assessment remains unclear.
Purpose of the Study:
- To document the vital signs and clinical features utilized by GPs for assessing children under five with acute infections.
- To understand current practices in vital sign measurement for pediatric acute infections.
Main Methods:
- A questionnaire survey was distributed to 210 GP principals within a 10-mile radius of Oxford, UK.
- Data collected included the frequency, methods, and perceived utility of vital sign measurement.
- Clinical features were used to evaluate the severity of illness.
Main Results:
- 162 GPs responded (77% response rate).
- Temperature was measured weekly by 54% of GPs, while pulse and respiratory rates were measured less frequently (21% and 17%, respectively).
- Capillary refill time was not measured by 48% of GPs. GPs found behavioral observations more useful than vital signs for assessing severity.
Conclusions:
- Vital signs are infrequently measured in general practice for children and are perceived as less valuable than observation for assessing illness severity.
- Urgent attention is needed to address inaccuracies in measurement and establish the diagnostic value of vital signs if they are to be integrated into standard pediatric care.
Background:
GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known.
Aim:
To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections.
Design Of Study:
Questionnaire survey.
Setting:
All 210 GP principals working within a 10 mile radius of Oxford, UK.
Method:
Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness.
Results:
One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness.
Conclusion:
Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.
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