Ivu En Niños

BMC Family Practice
Research article

BioMed Central

Open Access

Signs and symptoms in children with a serious infection: a qualitative study
Ann Van den Bruel*1, Rudi Bruyninckx1, Etienne Vermeire1,2, Peter Aerssens3, Bert Aertgeerts1 and Frank Buntinx1,4
Address: 1Department of General Practice, Katholieke Universiteit Leuven, Kapucijnenvoer 33 Blok J, 3000 Leuven, Belgium,2Department of General Practice, Universtaire Instelling Antwerpen, Universiteitsplein 1, 2610 Wilrijk, Belgium, 3Department of Pediatrics, Virga Jesseziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium and 4Department of General Practice, Universiteit Maastricht, Postbus 616, 6200 MD Maastricht, The Netherlands Email: Ann Van den Bruel* - ann.vandenbruel@med.kuleuven.ac.be; Rudi Bruyninckx -rudi.bruyninckx@med.kuleuven.ac.be; Etienne Vermeire - etienne.vermeire@ua.ac.be; Peter Aerssens - peter.aerssens@skynet.be; Bert Aertgeerts - bert.aertgeerts@med.kuleuven.ac.be; Frank Buntinx - frank.buntinx@med.kuleuven.ac.be * Corresponding author

Published: 26 August 2005 BMC Family Practice 2005, 6:36 doi:10.1186/1471-2296-6-36

Received: 14 December 2004 Accepted: 26 August 2005

This article isavailable from: http://www.biomedcentral.com/1471-2296/6/36 © 2005 Van den Bruel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

AbstractBackground: 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: 18children 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. Childreneither 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. Conclusion: 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.

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BMC Family Practice 2005, 6:36

http://www.biomedcentral.com/1471-2296/6/36

Background
Ingeneral practice, the incidence of acute infections is high. The yearly incidence can be as high as 41%, with acute upper respiratory infections as the most frequent diagnosis and highest incidence rates in children less than 1 year old[1]. In contrast, serious and possibly life-threatening infections are rare, their yearly incidence in children being estimated at 1.5%[2]. The most frequent...