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SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern
Giorgio Cozzi1, Antimo Tessitore2, Manuela Giangreco1
1Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
Insights
Pediatricians' "gut feeling" and abnormal breathing patterns are key indicators for severe bacterial infections (SBI) in children. While these signs aid in detection, their overall sensitivity for identifying SBI remains low.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Severe bacterial infections (SBI) contribute to pediatric mortality, posing diagnostic challenges in early stages.
- Accurate identification of SBI is crucial for timely intervention in children under 5.
Purpose of the Study:
- To estimate the prevalence of SBI in a pediatric population.
- To identify clinical signs and symptoms indicative of possible SBI in children.
Main Methods:
- A prospective, multicenter study enrolled children aged 0-14 years presenting to the emergency department with acute illness.
- Data on variables suggestive of SBI were collected, with patients followed up by telephone one week post-enrollment.
Main Results:
- A pediatrician's "gut feeling" significantly increased the likelihood of detecting SBI in both univariate and multivariate analyses.
- An abnormal breathing pattern was also significant in univariate analysis but had low associated sensitivity.
- SBI is rarely detected without these indicators.
Conclusions:
- Pediatricians' intuition and observation of abnormal respiratory patterns are important for identifying potential SBI cases.
- These clinical indicators, while valuable, have limited sensitivity for definitively diagnosing SBI.
Aim:
According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI.
Methods:
We designed a prospective, multicentre study and enrolled patients aged 0-14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone.
Results:
SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08-12.56; multivariate OR: 5.34, 95% CI: 2.78-10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98-7.40). Nevertheless, their associated sensitivity is low.
Conclusion:
SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.
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