title: Which symptoms and clinical features correctly identify serious respiratory infection in children attending a paediatric assessment unit?
abstract: OBJECTIVE
  Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment.
  
  
  METHODS
  Prospective diagnostic cohort study.
  
  
  METHODS
  Paediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust.
  
  
  METHODS
  535 children aged between 3 months and 12 years with suspected acute infection.
  
  
  METHODS
  Parents completed a symptom questionnaire on arrival. Children were triaged by a nurse, who measured routine vital signs. The final diagnosis at discharge was used as the outcome. Symptoms and triage findings were analysed to identify features diagnostic of serious respiratory infection. Agreement between parent and triage nurse assessment was measured and kappa values calculated.
  
  
  RESULTS
  Parent-reported symptoms were poor indicators of serious respiratory infection (positive likelihood ratio (LR+) 0.56-1.93) and agreed poorly with nurse assessment (kappa 0.22-0.56). The best predictor was clinical assessment of respiratory distress (LR+ 5.04). Oxygen saturations <94% were highly specific (specificity 95.1%) but had poor sensitivity (35.6%). Tachypnoea (defined by current Advanced Paediatric Life Support standards) offered little discriminatory value.
  
  
  CONCLUSIONS
  Parent-reported symptoms were unreliable discriminators of serious respiratory infection in children with suspected acute infection, and did not correlate well with nurse assessment. Using symptoms to identify higher risk children in this setting is unreliable. Nurse triage assessment of respiratory distress and some vital signs are important predictors.
authors.affiliation: Department of Primary Health Care, Oxford University, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK. claire.blacklock@dphpc.ox.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Blacklock
authors.forename: R
authors.initials: R
authors.lastname: Mayon-White
authors.forename: N
authors.initials: N
authors.lastname: Coad
authors.forename: M
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009730:Nursing Assessment; D015588:Observer Variation; D010290:Parents; D010371:Pediatric Nursing; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis*; D013610:Tachycardia / Q000382:microbiology; D014218:Triage / Q000379:methods*; D055986:Vital Signs