Red flags could help identify children with serious infections

February 3, 2010, Oxford University
Red flags could help identify children with serious infections
Red flags could used routinely by doctors to help spot the few children that may have a serious infection from the many with minor coughs and colds.

( -- A set of warning signs -- or red flags -- that can be used routinely by doctors to help spot the few children that may have a serious infection from the many with minor coughs and colds, has been identified by a European team led by researchers at the Katholieke Universiteit Leuven in Belgium and Oxford University.

They were able to put together the list of red flags through a review of the available research evidence. Their systematic review is published in the medical journal, the Lancet.

Serious infections like meningitis, pneumonia or sepsis are rare in developed countries and can be difficult to diagnose among the many coming into GP surgeries, paediatric assessment units and emergency departments. Detecting serious infections rapidly improves prognosis by allowing appropriate actions to be taken, such as referral to hospital.

‘For doctors, it’s a bit like finding a needle in a haystack,’ says Dr Matthew Thompson of the Department of at the University of Oxford, a co-author of the study. ‘Serious infections are rare and getting increasingly rarer thanks to vaccinations. Identifying that one child out of all those many with minor ailments is difficult. It is complicated further as the child may be seen at any early stage of infection before it is possible to recognise its severity.’

Rapid breathing, at the skin and extremities, and rashes of small purple red spots were identified as red flags that can help confirm the possibility of a serious infection. A high temperature over 40°C is a warning sign among children seen in surgeries and paediatric assessment units. However, the absence of these clinical signs could not rule out serious illness.

‘Doctors should routinely check for these warning signs in every sick child they see,’ says lead author Dr Ann Van den Bruel, who has just moved to the University of Oxford from KU Leuven and who is also a GP. ‘For example, not all GPs will check a child’s temperature, whereas we would now suggest this is done on all occasions.

’The doctor’s instinct or gut feeling is the best clinical predictor of serious infection. Parental concern is also a good warning sign that an illness is serious among children being assessed at GP surgeries.

‘As a GP, it’s important to always be alert to parents who are especially concerned about their child,’ says Dr Thompson, who is also a GP. ‘We should usually trust parents’ instincts, after all they will have nursed their child through many minor illnesses before and often can tell when something is different.’

Dr Van den Bruel adds: ‘Parents shouldn’t try to assess these red flags themselves, it would only add to any uncertainty or anxiety they may already be feeling. However, parents can take heart that we found they are very good at picking up signs that their child is unwell.

‘Parental concern is a good diagnostic indicator for something being seriously wrong, and doctors need to take that into account in combination with other clinical information.’

Having identified these red flags, the research team now aims to develop guidelines for what actions should then be taken for the best outcomes, so that children are referred to hospitals quickly and only where appropriate.

Related Stories

Recommended for you

First proof a synthesized antibiotic is capable of treating superbugs

March 23, 2018
A "game changing" new antibiotic which is capable of killing superbugs has been successfully synthesised and used to treat an infection for the first time—and could lead to the first new class of antibiotic drug in 30 years.

Scientists identify potential drug target in blood-feeding hookworms

March 22, 2018
In hookworms that infect and feed on the blood of mice, scientists have discovered a key step in blood digestion that can be targeted to disrupt the parasite's development and survival. These findings, published in PLOS Pathogens ...

Global burden of low back pain—a consequence of negligence and misinformation

March 21, 2018
A series of groundbreaking papers from Australian and international researchers in The Lancet, published today (22/3) warns that low back pain is a major health burden globally - across developed and developing nations - ...

Microscopic 'shuttles' transport enzyme from cells to trigger onset of kidney disease

March 21, 2018
A new study involving the University of Sheffield has identified a key culprit in the onset of kidney disease in a major marker for kidney disease development.

Metabolite therapy proves effective in treating C. difficile in mice

March 20, 2018
A team of UCLA researchers found that a metabolite therapy was effective in mice for treating a serious infection of the colon known as Clostridium difficile infection, or C. difficile.

Study of COPD patients has created a 'looking glass' into genome of pathogen

March 19, 2018
Decades of work on chronic obstructive pulmonary disease (COPD) at the University at Buffalo and the Veterans Affairs Western New York Healthcare System have yielded extraordinary information about the pathogen that does ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.