title: Signs and symptoms in children with a serious infection: a qualitative study.
abstract: BACKGROUND
  Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables.
  
  
  METHODS
  Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital.
  
  
  RESULTS
  18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent.
  
  
  CONCLUSIONS
  behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Belgium. ann.vandenbruel@med.kuleuven.ac.be
authors.forename: Ann
authors.initials: A
authors.lastname: Van den Bruel
authors.forename: Rudi
authors.initials: R
authors.lastname: Bruyninckx
authors.forename: Etienne
authors.initials: E
authors.lastname: Vermeire
authors.forename: Peter
authors.initials: P
authors.lastname: Aerssens
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D001530:Belgium; D002648:Child; D002652:Child Behavior; D002673:Child, Hospitalized / Q000523:psychology*; D002675:Child, Preschool; D003448:Crying; D005194:Family Practice / Q000379:methods*; D005334:Fever; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000175:diagnosis* / Q000523:psychology; D007407:Interviews as Topic; D007508:Irritable Mood; D010290:Parents; D010372:Pediatrics / Q000379:methods*; D036301:Qualitative Research; D012894:Sleep Stages; D011795:Surveys and Questionnaires; D013997:Time Factors