Observation scales to identify serious illness in febrile children
McCarthy, P.L.; Sharpe, M.R.; Spiesel, S.Z.; Dolan, T.F.; Forsyth, B.W.; DeWitt, T.G.; Fink, H.D.; Baron, M.A.; Cicchetti, D.V.
Pediatrics 70(5): 802-809
1982
ISSN/ISBN: 0031-4005 PMID: 7133831 Document Number: 194980
The pediatrician makes a judgment of the degree of illness (toxicity) of a febrile child based on observation prior to history and physical examination. In order to define valid and reliable observation data for that judgment, data from 2 previous studies were used to construct 3-point scales of 14 observation items correlated with serious illness in those reports. Between Nov. 1, 1980 and March 1, 1981, these 14 scaled items were scored simultaneously by attending physicians, residents and nurses prior to history and physical examination on 312 febrile children aged .ltoreq. 24 mo. seen consecutively in the Primary Care Center-Emergency Room and in 1 private practice. Of these 312 children, 37 had serious illness. Multiple regression analysis based on patients seen by at least 1 attending physician in the Primary Care Center revealed 6 items (quality of cry, reaction to parents, state variation, color, state of hydration and response to social overtures) that were significant and independent predictors of serious illness (multiple R = 0.63). The observed agreement for scoring these 6 items between 2 attending physicians who saw 1/3 of the patients ranged from 88%-97%. The chance corrected agreement levels (KW) for these 6 items were, with one exception, clinically significant (KW = 0.47-0.73). A discriminant function analysis revealed that these 6 items when used together had a specificity of 88% and a sensitivity of 77% for serious illness. Individual scores for each of the 6 key items were added to yield a total score for each patient. Only 1.7% of patients with a score .ltoreq. 10 had a serious illness; 92.3% with a score .gtoreq. 16 had a serious illness. The sensitivity of the 6-item model for serous illness when combined with history and physical examination was 92%. In the population studied, this predictive model, when used prior to history and physical examination, was reliable, predictive, specific and sensitive for serious illness in febrile children. It was most sensitive when combined with history and physical examination. The model will need to be validated on a new population of patients.