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When and how do GPs record vital signs in children with acute infections? A cross-sectional study
Claire Blacklock1, Tanya Ali Haj-Hassan, Matthew J Thompson
1Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
General practitioners (GPs) infrequently document vital signs for children with acute infections. While numerical recording is low, including free text improves documentation rates, highlighting a gap in clinical practice for pediatric infection assessment.
Area of Science:
- Pediatric infectious disease
- General practice and primary care
- Clinical documentation and practice
Background:
- National Institute for Health and Care Excellence (NICE) guidelines advocate for vital sign measurement in identifying serious pediatric infections.
- Ambulatory care evidence supports vital signs for early detection of severe illness in children.
- Clinical practice among General Practitioners (GPs) appears to involve infrequent measurement of vital signs in children.
Purpose of the Study:
- To determine the frequency of vital sign documentation by GPs during the assessment of children with acute infections in primary care settings.
- To investigate the methods GPs use for documenting vital signs, including numerical values and descriptive text.
- To compare documentation rates with recommended clinical guidelines.
Main Methods:
- An observational study was conducted across 15 general practices in Oxfordshire and Somerset, UK.
- A standardized proforma was utilized to extract data on 850 children (aged 1 month to 16 years) presenting with acute infections.
- Data collected included documented numerical vital signs and GP-recorded words or phrases used in assessing vital signs.
Main Results:
- Only 31.6% of children had at least one numerical vital sign recorded.
- Inclusion of free-text descriptions increased vital sign documentation to over half (54.1%) of cases.
- Temperature was the most frequently recorded numerical vital sign (24.7%), followed by heart rate (7.3%) and respiratory rate (6.8%).
- Documentation of vital signs using words or phrases was infrequent, with temperature noted in 17.6% and respiratory rate in 14.6%.
Conclusions:
- GPs utilize both numerical data and descriptive language for vital sign documentation in pediatric acute infections.
- Overall documentation of vital signs in children presenting with acute infections remains infrequent in primary care.
- There is a discrepancy between recommended practice and actual clinical documentation of vital signs in this pediatric population.
Background:
NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently.
Aim:
To identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care.
Design And Setting:
Observational study in 15 general practice surgeries in Oxfordshire and Somerset, UK.
Method:
A standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection.
Results:
Of the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations.
Conclusion:
GPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections.
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