Identifying the sick childA short presentation

Inspired by twitter conversations

Dr. Damian Roland (@damian_roland)NIHR Doctoral Research Fellow in Paediatric Emergency Medicine

Paediatric Emergency Medicine Leicester Academic GroupA social enterprise to improve the care of the ill or injured child

Thanks @njoshi8 !

A problem…Children and Infants seeking urgent care

continue to increase

http://adc.bmj.com/content/98/5/328.abstractGill Arch Dis Child 2013;98:328-334

The majority of children will, even without treatment, be well.

http://www.ncbi.nlm.nih.gov/pubmed/20406860Craig BMJ 2010 ; 340:c1594

A conundrum…

The low incidence of disease protects the incompetent

i.e. you can perform poorly consistently and not be caught out!

BUT…………

A reality…

Background

Who makes the decision to Investigate?

“What I would really like to know is whether a procalcitonin level should ever prompt me to administer antibiotics to a child for whom

I otherwise would not, or allow me to safely withhold antibiotics from a child to whom I

would otherwise administer them”

Moran. Ann Emerg Med. 2012;60:601-602

And once made what test should it be?

“What I would really like to know is whether ANYTHING should ever prompt me to

administer antibiotics to a child for whom I otherwise would not, or allow me to safely withhold antibiotics from a child to whom I

would otherwise administer them”

Dr. Roland (every shift)

And does it really matter what the result is?

The ultimate conundrum

Looks Unwell Looks Well

Investigations: Sepsis Positive

Investigations: Sepsis Negative

Thoughts appreciated!

Dr. Damian Roland (dr98@le.ac.uk)

www.rolobotrambles.wordpress.comwww.pemla.com

Seewww.spottingthesickchild.comfor free access to a hundreds of video clipsof unwell and well children

Paediatric Observation Priority Score(available at the app store)