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Evaluation of temperature-pulse centile charts in identifying serious bacterial illness: observational cohort study

Andrew J Brent1, Monica Lakhanpaul, Nelly Ninis

  • 1Working Group on Recognising Acute Illness in Children, Royal College of Paediatrics and Child Health, London, UK. dr.a.brent@gmail.com

Archives of Disease in Childhood
|January 15, 2011
PubMed

Insights

Increased pulse rate is a key indicator for serious bacterial infection (SBI) in children. Temperature-pulse charts were less effective than pulse rate alone in predicting SBI risk.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Disease Diagnostics
  • Clinical Assessment Tools

Background:

  • Differentiating serious bacterial infections (SBI) from self-limiting infections in children is challenging.
  • Vital sign interpretation is complicated by temperature effects on pulse and respiratory rates.
  • Temperature-pulse centile charts have been proposed to enhance pulse rate's predictive value for SBI.

Purpose of the Study:

  • To evaluate the effectiveness of temperature-pulse centile charts in the clinical assessment of children with suspected SBI.
  • To compare the predictive value of temperature-pulse centile categories, pulse centile categories, and Advanced Paediatric Life Support (APLS) defined tachycardia for SBI.

Main Methods:

  • A comparative study involving 1360 children (3 months to 10 years) presenting with suspected infection to an English emergency department (ED).
  • Analysis of 325 children presenting to UK hospitals with meningococcal disease.
  • Assessment of predictive values for SBI using temperature-pulse centile categories, pulse centile categories, and APLS-defined tachycardia.

Main Results:

  • Pulse centile category strongly predicted SBI risk (p=0.0005), unlike temperature-pulse centile category (p=0.288).
  • APLS-defined tachycardia was also a significant predictor of SBI (OR 2.90).
  • In meningococcal disease cases, higher pulse and temperature-pulse centile categories correlated with disease severity.

Conclusions:

  • Elevated pulse rate is a crucial predictor of SBI, aligning with recommendations for routine measurement in febrile children.
  • Temperature-pulse centile charts demonstrated lower utility than pulse rate alone in this study.
  • Further research is needed to explore the role of these charts in monitoring clinical progress over time.
Abstract

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