Abstract

Feverish illness is one of the most common reasons for children to consult primary care. Infections account for 40% of all new episodes in general practice, and 29% of all consultations. Childhood infections also continue to have a major impact on secondary care: there has been a 40% increase in the number of children presenting to the emergency department; 14% of children present with febrile illness. Emergency hospital admission rates have increased by 28% from 1999 to 2010, mostly for acute infections. Paradoxically, serious infections have become increasingly rare and are now estimated to constitute <1% of childhood infections presenting to primary care. Serious infections in primary care are dominated by pneumonia, with urinary tract infection in second place, and very few cases now of sepsis, meningitis, or osteomyelitis. While most children suffer from self-limiting illnesses requiring little medical intervention, prompt recognition of the few children with a serious infection is essential to optimise prognosis. The key priority in primary care is therefore deciding whether a child is unwell enough to need immediate referral to hospital, or, whether they can be managed at home. One reason for the increasing pressure on health services is the difficulty in identifying serious infections, especially in the early stages of the disease when signs and symptoms are unspecific. Up to half of children with meningococcal disease are not identified at first contact.1 Symptoms and signs are the first and often only information available to support clinical decision making in primary care. Despite their central role, evidence on their value in primary care settings is surprisingly scarce. Of the 30 diagnostic studies on clinical features for serious infection in children identified in a systematic review, only a single study (of 4000 children in Belgium) was performed in primary care.2 Given that initial assessment …

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