Value of parental concern and clinician's gut feeling in recognition of serious bacterial infections: a prospective observational study
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Urzula Nora Urbane1, Dita Gaidule-Logina2, Dace Gardovska3
1Department of Pediatrics, Riga Stradins University, Vienibas Gatve 45, Riga, LV-1004, Latvia. urzula.urbane@rsu.lv.
Insights
Clinician's sense of reassurance effectively rules out serious bacterial infections (SBI) in children. However, parental concern and clinician's gut feeling were not significant predictors of SBI in this emergency department study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Serious bacterial infections (SBI) are a major global cause of mortality.
- Parental concern and clinician intuition have been linked to increased SBI likelihood in primary care.
- This study evaluated the diagnostic utility of these factors in a tertiary hospital emergency department.
Purpose of the Study:
- To assess the diagnostic value of parental concern and clinician's gut feeling in identifying serious bacterial infections (SBI) in pediatric emergency department patients.
- To determine the predictive accuracy of "sense of reassurance" and "gut feeling" for SBI.
- To evaluate the prognostic rule-in value of parental concern for SBI.
Main Methods:
- Prospective observational study of children with fever in a pediatric emergency department.
- Data collection through parental and clinician questionnaires.
- Statistical analysis using Pearson's Chi-Squared or Fisher's exact test and calculation of positive likelihood ratios.
Main Results:
- A "sense of reassurance" by clinicians was associated with a lower likelihood of SBI (PLR 8.8).
- "Gut feeling" was not a significant predictor of SBI (PLR 3.1).
- Parental concern showed insignificant prognostic rule-in value for SBI (PLR 1.4).
Conclusions:
- Clinician "sense of reassurance" is a useful tool for ruling out serious bacterial infections (SBI) in children.
- Parental concern was not found to be a significant predictor of SBI in this emergency department setting.
Background:
Serious bacterial infections (SBI) are a significant cause of mortality worldwide. Parental concern and clinician's gut feeling that there is something wrong has been associated with increased likelihood of developing SBI in primary care studies. The aim of this study is to assess the diagnostic value of parental concern and gut feeling at the emergency department of a tertiary hospital.
Methods:
This prospective observational study included children with fever attending the emergency department of Children's Clinical University hospital in Riga between October 2017 and July 2018. Data were collected via parental and clinician questionnaires. "Gut feeling" was defined as intuitive feeling that the child may have a serious illness, and "Sense of reassurance" as a feeling that the child has a self-limiting illness. "Parental concern" was defined as impression that this illness is different from previous illnesses. SBI included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, appendicitis, bacterial gastroenteritis, and osteomyelitis. Pearson's Chi-Squared test or Fisher's exact test were used to compare the variables between children with and without SBI. Positive likelihood ratio was calculated for "gut feeling", "sense of reassurance", and parental concern.
Results:
The study included 162 patients aged 2 months to 17.8 years. Forty-six patients were diagnosed with SBI. "Sense of reassurance" expressed by all clinicians was associated with lower likelihood of SBI (positive likelihood ratio 8.8, 95% confidence interval 2.2-34.8). "Gut feeling" was not significantly predictive of the patient being diagnosed with SBI (positive likelihood ratio 3.1, 95% confidence interval 1.9-5.1), The prognostic rule-in value of parental concern was insignificant (positive likelihood ratio 1.4, 95% confidence interval 1.1-1.7).
Conclusion:
Sense of reassurance was useful in ruling out SBI. Parental concern was not significantly predictive of SBI.