Clinicians' gut feeling about serious infections in children: observational study.
Clinicians' gut feeling about serious infections in children: observational study.
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DOI：
10.1136/bmj.e6144
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发表时间：
2012-09-25
期刊：
影响因子：
--
通讯作者：
Mant D
中科院分区：
文献类型：
--
作者：
Van den Bruel A;Thompson M;Buntinx F;Mant D
目的探讨临床医生“直觉”认为儿童感染比临床评估的严重程度的依据和附加值。设计观察性研究。设置初级保健设置，弗兰德斯，比利时。参与者3890名0-16岁的儿童和青少年在初级保健中的连续系列。主要观察指标：表现特征、临床评估、医生在初级保健中首次接触儿童时的直观反应，以及根据医院记录确定的任何后续严重感染诊断。结果在3369名儿童和青少年中，临床评估为非严重疾病，6人（0.2%）随后因严重感染入院。尽管临床评估为非严重疾病，但直觉上有些问题大大增加了严重疾病的风险（似然比25.5，95%置信区间7.9至82.0），并根据这种直觉采取行动，有可能防止6例病例中的2例被遗漏（33%，95%置信区间4.0%至100%），代价是44个假警报（1.3%，95%置信区间0.95%至1.75%）。与肠道感觉最密切相关的临床特征是儿童的总体反应（嗜睡，不笑），呼吸异常，体重减轻和抽搐。最强的背景因素是父母担心疾病与他们以前的经历不同（比值比36.3，95%置信区间12.3至107）。结论：对儿童疾病严重性的直觉是临床医生对父母的担忧和儿童外观的本能反应。它应该引发行动，如寻求第二意见或进一步调查。观察到的直觉和严重感染的临床标志物之间的关联意味着，通过反思他们的直觉的起源，临床医生应该能够磨练他们的临床技能。
Objective To investigate the basis and added value of clinicians’ “gut feeling” that infections in children are more serious than suggested by clinical assessment. Design Observational study. Setting Primary care setting, Flanders, Belgium. Participants Consecutive series of 3890 children and young people aged 0-16 years presenting in primary care. Main outcome measures Presenting features, clinical assessment, doctors’ intuitive response at first contact with children in primary care, and any subsequent diagnosis of serious infection determined from hospital records. Results Of the 3369 children and young people assessed clinically as having a non-severe illness, six (0.2%) were subsequently admitted to hospital with a serious infection. Intuition that something was wrong despite the clinical assessment of non-severe illness substantially increased the risk of serious illness (likelihood ratio 25.5, 95% confidence interval 7.9 to 82.0) and acting on this gut feeling had the potential to prevent two of the six cases being missed (33%, 95% confidence interval 4.0% to 100%) at a cost of 44 false alarms (1.3%, 95% confidence interval 0.95% to 1.75%). The clinical features most strongly associated with gut feeling were the children’s overall response (drowsiness, no laughing), abnormal breathing, weight loss, and convulsions. The strongest contextual factor was the parents’ concern that the illness was different from their previous experience (odds ratio 36.3, 95% confidence interval 12.3 to 107). Conclusions A gut feeling about the seriousness of illness in children is an instinctive response by clinicians to the concerns of the parents and the appearance of the children. It should trigger action such as seeking a second opinion or further investigations. The observed association between intuition and clinical markers of serious infection means that by reflecting on the genesis of their gut feeling, clinicians should be able to hone their clinical skills.
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影响因子：
2.9
作者：
Bruyninckx, Rudi;Van den Bruel, Ann;Aertgeerts, Bert
通讯作者：
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影响因子：
3.6
作者：
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通讯作者：
DerksenLubsen, G
影响因子：
3.6
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
168.9
作者：
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通讯作者：
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