GPs ‘should act on gut feeling’
medwireNews: GPs should take action if they have a gut feeling that a child may be seriously ill, even if clinical examination suggests otherwise, say researchers.
They report in the BMJ that a doctor's intuitive feeling that "something is wrong" can significantly reduce the number of missed serious cases, without causing an unmanageable number of false alarms.
Dr Ann Van den Buel (University of Oxford) and colleagues found that among 3,890 children initially assessed as having non-severe illness, acting on gut feeling could have prevented two out of six cases that turned out to be serious infections being missed at the initial consultation, albeit at a cost of 44 false alarms.
Features that gave rise to a gut feeling of something serious were generally unsurprising, note the authors, such as the child's overall response (drowsiness, no laughing), breathing pattern, weight loss, and history of convulsions. GPs were also strongly influenced by parental concern, specifically that the illness was different from any previously experienced.
Interestingly, finding a high temperature did not give rise to a gut feeling of something being seriously wrong, although the authors note that this may be because it correlated closely with other features that did - in particular parental concern, which itself is likely to be influenced by temperature.
Nevertheless, they stress: "It is important that primary care clinicians recognise the diagnostic value of fever in their clinical assessment - for every 20 children with a temperature of 40°C or more in a primary setting, one will have a serious infection."
medwireNews (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Caroline Price