Computer model better than clinical judgment for diagnosing fever in young children

April 21, 2010, British Medical Journal

A computerised diagnostic model outperforms clinical judgement for the diagnosis of fever in young children, and may improve early treatment, finds a study published in the British Medical Journal today.

Fever (or febrile illness) is a common symptom in children, especially in those under five years of age, but it can be difficult to diagnose the correct cause. Yet physicians need to be able to distinguish minor viral illnesses from serious bacterial infections such as , urinary tract infection and meningitis.

Current diagnostic processes and clinical scoring systems are often inadequate, so there is a real need for an accurate acute clinical decision making tool that takes into account all the signs and symptoms associated with serious causes of febrile illness.

So a team of researchers in Australia set out to develop and test a computerised model to distinguish serious bacterial infections from self limiting non-bacterial illnesses.

The study involved over 15,000 healthy children under five years of age presenting to the of a large children's hospital over a two-year period with a febrile illness (a body temperature of 38ºC or more in the previous 24 hours).

A standard clinical evaluation was performed by physicians and serious bacterial infections were confirmed or excluded using standard tests and follow up. The signs and symptoms noted by the physicians were then combined in a diagnostic model and the results were compared.

The data show that , pneumonia and bacteraemia (bacteria in the blood) occur in about 7% of young children with a fever, but only 70-80% of these children are prescribed antibiotics on initial consultation and 20% of children without an
identified are probably over-treated with antibiotics.

The performance of the diagnostic model for each infection was acceptable or better than physician evaluation.

The authors point out that almost all (95%) of these children had the appropriate tests, and that some doctors routinely delay giving antibiotics until test results are known, so this may help to explain the initial under-treatment. However, about two thirds of children who were not treated were subsequently prescribed antibiotics.

They conclude: "By combining routinely collected clinical information into a statistical model, we have demonstrated that a clinical diagnostic model may improve the care of children presenting with fever who have suspected serious bacterial illness."

"This study reinforces the importance of measuring vital signs and assessing a child's overall state of illness," say general practitioners Matthew Thompson and Anne Van den Bruel in an accompanying editorial. But, they caution that, "before widespread implementation, we will need to have evidence showing the effect of using such a model on patient management and outcomes."

Related Stories

Recommended for you

Ambitious global virome project could mark end of pandemic era

February 23, 2018
Rather than wait for viruses like Ebola, SARS and Zika to become outbreaks that force the world to react, a new global initiative seeks to proactively identify, prepare for and stop viral threats before they become pandemics.

Forecasting antibiotic resistance with a 'weather map' of local data

February 23, 2018
The resistance that infectious microbes have to antibiotics makes it difficult for physicians to confidently select the right drug to treat an infection. And that resistance is dynamic: It changes from year to year and varies ...

Study reveals how kidney disease happens

February 22, 2018
Monash researchers have solved a mystery, revealing how certain immune cells work together to instigate autoimmune kidney disease.

Scientists gain new insight on how antibodies interact with widespread respiratory virus

February 22, 2018
Scientists have found and characterized the activity of four antibodies produced by the human immune system that target an important protein found in respiratory syncytial virus (RSV), according to new research published ...

Past encounters with the flu shape vaccine response

February 20, 2018
New research on why the influenza vaccine was only modestly effective in recent years shows that immune history with the flu influences a person's response to the vaccine.

Building better tiny kidneys to test drugs and help people avoid dialysis

February 16, 2018
A free online kidney atlas built by USC researchers empowers stem cell scientists everywhere to generate more human-like tiny kidneys for testing new drugs and creating renal replacement therapies.

0 comments

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.