Using vital signs to assess children with acute infections: a survey of current practice.
BACKGROUND
GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known.


OBJECTIVE
To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections.


METHODS
Questionnaire survey.


METHODS
All 210 GP principals working within a 10 mile radius of Oxford, UK.


METHODS
Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness.


RESULTS
One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness.


CONCLUSIONS
Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.
Thompson
Matthew
M
Oxford University Department of Primary Health Care, Old Road Campus, Oxford, UK. matthew.thompson@dphpc.ox.ac.uk
Mayon-White
Richard
R
Harnden
Anthony
A
Perera
Rafael
R
McLeod
Diane
D
Mant
David
D
D000208:Acute Disease; D001831:Body Temperature; D002675:Child, Preschool; D004739:England; D005194:Family Practice; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007239:Infections / Q000175:diagnosis*; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D011364:Professional Practice / Q000706:statistics & numerical data*; D011674:Pulse; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires