Clinical markers of serious illness in young infants: a multicentre follow-up study.
OBJECTIVE
To perform a multicentre follow-up study to determine if previously identified markers of serious illness in early infancy were robust and statistically reliable.


METHODS
Infants aged 1 week to 26 weeks presenting to the Emergency Departments of the Royal Children's Hospital and two Melbourne metropolitan hospitals were seen over a 12-month period. Eleven clinical markers as well as their temperature were documented by nursing staff and resident medical officers. Serious illness was defined if infants had a positive body fluid bacterial culture, a positive chest X-ray or if significant treatment was required in hospital. The predictive values, sensitivity and specificity for the individual and the best combination of clinical markers were determined.


RESULTS
Assessments (3806) were performed with 312 infants being assessed as seriously ill (8.2%). The combination of either drowsiness on history or examination, pallor on history or examination, breathing difficulty (chest wall recession), temperature above 38 degrees C and a lump being present, identified 82.5% of all babies deemed subsequently to be seriously ill. The positive predictive value of an infant who was febrile, drowsy and pale on examination was 70.7% (previous study 74%).


CONCLUSIONS
This study confirmed the high individual predictive value of arousal variables, pallor, and chest wall recession, especially when associated with fever, reaffirming their utility in the recognition of serious illness in infants under 6 months of age.
Hewson
P
P
Department of Paediatrics, Geelong Hospital, University of Melbourne, Melbourne, Victoria, Centre for Community Child Health, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria. phewson@tpg.com.au
Poulakis
Z
Z
Jarman
F
F
Kerr
J
J
McMaster
D
D
Goodge
J
J
Silk
G
G
D015415:Biomarkers / Q000032:analysis*; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000628:therapy; D016638:Critical Illness; D004066:Digestive System Diseases / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000628:therapy; D007239:Infections / Q000175:diagnosis / Q000628:therapy; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014777:Virus Diseases / Q000175:diagnosis / Q000628:therapy
D015415:Biomarkers