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01-01-2011 | Onderzoek
Klinische signalen van ernstige infecties bij kinderen
Auteurs: Ann van den van den Bruel, MD PhD, Tanya Haj-Hassan, BA, MSc, Matthew Thompson, MRCGP, MPH, DPhil, Frank Buntinx, MD PhD, David Mant, FRCGP, FRCP, ERNIE-onderzoekers
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Samenvatting
Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D; ERNIE-onderzoekers. Klinische signalen van ernstige infecties bij kinderen. Huisarts Wet 2011;54(1):7–11.
DoelAchterhalen welke klinische tests men in ontwikkelde landen zou kunnen gebruiken om in een ambulante setting ernstige infecties bij kinderen aan te tonen of uit te sluiten.
MethodeSystematische review van onderzoeken, gevonden in Medline, Embase, DARE, CINAHL en referentielijsten, en na consultatie van deskundigen. De onderzoeken voldeden aan zes criteria: design (onderzoeken naar diagnostische accuratesse of predictieregels); deelnemers (verder gezonde kinderen tussen 1 maand en 18 jaar); setting (ambulante zorg); uitkomst (ernstige infectie); tests (uitvoerbaar in een ambulante setting); en voldoende data gerapporteerd. Tests met een positieve likelihood ratio (LR+) groter dan 5 beschouwden wij als alarmsignalen; tests met een negatieve likelihood ratio (LR–) kleiner dan 0,2 als uitsluiters.
ResultatenWij includeerden dertig onderzoeken, waarvan één gedaan in de huisartsenpraktijk. De betrouwbaarste alarmsignalen voor een ernstige infectie waren cyanose, snelle ademhaling, slechte perifere circulatie en petechiën. In de huisartsenpraktijk zijn ook ongerustheid bij de ouders (LR+ 14) en een ‘nietpluisgevoel’ bij de arts (LR+ 23) sterke alarmsignalen, en in settings met een lage prevalentie is een temperatuur boven 40 °C eveneens een alarmsignaal. Geen enkele klinische test bleek een ernstige infectie te kunnen uitsluiten, maar enkele eenvoudige combinaties kunnen dit wel – bijvoorbeeld pneumonie is erg onwaarschijnlijk (LR– 0,07) als het kind niet kortademig is en de ouders niet ongerust zijn. De Yale Observation Scale stelt teleur zowel voor het aantonen (LR+ 1,1–6,7) als voor het uitsluiten van ernstige infecties (LR– 0,16–0,97).
ConclusieHuisartsen moeten bij een ziek kind altijd bedacht zijn op alarmsignalen voor ernstige infecties, maar zullen nooit alle ernstige infecties tijdig signaleren. Een goede vangnetstrategie is daarom noodzakelijk, met inschakeling van de ouders. De arts zou daarbij explicieter moeten aangeven bij welk risiconiveau hij tot actie overgaat.
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Literatuur
1.
go back to reference CEMACH. Why children die: A pilot s tudy 2006. London: Confidential Enquiry into Maternal and Child Health (CEMACH), 2008.
CEMACH. Why children die: A pilot s tudy 2006. London: Confidential Enquiry into Maternal and Child Health (CEMACH), 2008.
2.
go back to reference Bruijnzeels MA, Foets M, Van der Wouden JC, Van den Heuvel WJ, Prins A. Everyday symptoms in childhood: occurrence and general practitioner consultation rates. Br J Gen Pract 1998;48:880–884.PubMed
Bruijnzeels MA, Foets M, Van der Wouden JC, Van den Heuvel WJ, Prins A. Everyday symptoms in childhood: occurrence and general practitioner consultation rates. Br J Gen Pract 1998;48:880–884.PubMed
3.
go back to reference Fleming DM, Smith GE, Charlton JR, Charlton J, Nicoll A. Impact of infections on primary care: Greater than expected. Commun Dis Public Health 2002;5:7–12.PubMed
Fleming DM, Smith GE, Charlton JR, Charlton J, Nicoll A. Impact of infections on primary care: Greater than expected. Commun Dis Public Health 2002;5:7–12.PubMed
4.
go back to reference Armon K, Stephenson T, Gabriel V, MacFaul R, Eccleston P, Werneke U, et al. Determining the common medical presenting problems to an accident and emergency department. Arch Dis Child 2001;84:390–392.PubMedCrossRef
Armon K, Stephenson T, Gabriel V, MacFaul R, Eccleston P, Werneke U, et al. Determining the common medical presenting problems to an accident and emergency department. Arch Dis Child 2001;84:390–392.PubMedCrossRef
5.
go back to reference Van den Bruel A, Aertgeerts B, Bruyninckx R, Aerts M, Buntinx F. Signs and symptoms for diagnosis of serious infections in children: A prospective study in primary care. Br J Gen Pract 2007;57:538–546.PubMed
Van den Bruel A, Aertgeerts B, Bruyninckx R, Aerts M, Buntinx F. Signs and symptoms for diagnosis of serious infections in children: A prospective study in primary care. Br J Gen Pract 2007;57:538–546.PubMed
6.
go back to reference Kai J. What worries parents when their preschool children are acutely ill, and why: A qualitative study. Br Med J 1996;313:983–986.CrossRef
Kai J. What worries parents when their preschool children are acutely ill, and why: A qualitative study. Br Med J 1996;313:983–986.CrossRef
7.
go back to reference Riordan FA, Thomson AP, Sills JA, Hart CA. Who spots the spots? Diagnosis and treatment of early meningococcal disease in children. BMJ 1996;313:1255–1256.PubMedCrossRef
Riordan FA, Thomson AP, Sills JA, Hart CA. Who spots the spots? Diagnosis and treatment of early meningococcal disease in children. BMJ 1996;313:1255–1256.PubMedCrossRef
8.
go back to reference Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet 2006;367:397–403.PubMedCrossRef
Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet 2006;367:397–403.PubMedCrossRef
9.
go back to reference Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008;371:135–142.CrossRef
Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008;371:135–142.CrossRef
10.
go back to reference Duke T, Oa O, Mokela D, Oswyn G, Hwaihwanje I, Hawap J. The management of sick young infants at primary health centres in a rural developing country. Arch Dis Child 2005;90:200–205.PubMedCrossRef
Duke T, Oa O, Mokela D, Oswyn G, Hwaihwanje I, Hawap J. The management of sick young infants at primary health centres in a rural developing country. Arch Dis Child 2005;90:200–205.PubMedCrossRef
11.
go back to reference Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25.PubMedCrossRef
Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25.PubMedCrossRef
12.
go back to reference Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271:703–707.PubMedCrossRef
Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271:703–707.PubMedCrossRef
13.
go back to reference Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 2001;108:311–316.CrossRef
Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 2001;108:311–316.CrossRef
14.
go back to reference Bonadio WA, Hagen E, Rucka J, Shallow K, Stommel P, Smith D. Efficacy of a protocol to distinguish risk of serious bacterial infection in the outpatient evaluation of febrile young infants. Clin Pediatr (Phila) 1993;32:401–404.CrossRef
Bonadio WA, Hagen E, Rucka J, Shallow K, Stommel P, Smith D. Efficacy of a protocol to distinguish risk of serious bacterial infection in the outpatient evaluation of febrile young infants. Clin Pediatr (Phila) 1993;32:401–404.CrossRef
15.
go back to reference Lacour AG, Zamora SA, Gervaix A. A score identifying serious bacterial infections in children with fever without source. Pediatr Infect Dis J 2008;27:654–656.PubMedCrossRef
Lacour AG, Zamora SA, Gervaix A. A score identifying serious bacterial infections in children with fever without source. Pediatr Infect Dis J 2008;27:654–656.PubMedCrossRef
16.
go back to reference Garra G, Cunningham SJ, Crain EF. Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age. Acad Emerg Med 2005;12:921–925.PubMedCrossRef
Garra G, Cunningham SJ, Crain EF. Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age. Acad Emerg Med 2005;12:921–925.PubMedCrossRef
17.
go back to reference Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med 1993;329:1437–1441.PubMedCrossRef
Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med 1993;329:1437–1441.PubMedCrossRef
18.
go back to reference Baker MD, Bell LM, Avner JR. The efficacy of routine outpatient management without antibiotics of fever in selected infants. Pediatrics 1999;103:627–631.PubMedCrossRef
Baker MD, Bell LM, Avner JR. The efficacy of routine outpatient management without antibiotics of fever in selected infants. Pediatrics 1999;103:627–631.PubMedCrossRef
19.
go back to reference Nademi Z, Clark J, Richards CG, Walshaw D, Cant AJ. The causes of fever in children attending hospital in the north of England. J Infect 2001;43:221–225.PubMedCrossRef
Nademi Z, Clark J, Richards CG, Walshaw D, Cant AJ. The causes of fever in children attending hospital in the north of England. J Infect 2001;43:221–225.PubMedCrossRef
20.
go back to reference Thayyil S, Shenoy M, Hamaluba M, Gupta A, Frater J, Verber IG. Is procalcitonin useful in early diagnosis of serious bacterial infections in children? Acta Paediatr 2005;94:155–158.PubMedCrossRef
Thayyil S, Shenoy M, Hamaluba M, Gupta A, Frater J, Verber IG. Is procalcitonin useful in early diagnosis of serious bacterial infections in children? Acta Paediatr 2005;94:155–158.PubMedCrossRef
21.
go back to reference Thompson MJ, Coad N, Harnden A, Mayon-White R, Perera R, Mant D. How well do vital signs identify children with serious infections in paediatric emergency care? Arch Dis Child 2009;94:888–893.PubMedCrossRef
Thompson MJ, Coad N, Harnden A, Mayon-White R, Perera R, Mant D. How well do vital signs identify children with serious infections in paediatric emergency care? Arch Dis Child 2009;94:888–893.PubMedCrossRef
22.
go back to reference Nielsen HE, Andersen EA, Andersen J, Bottiger B, Christiansen KM, Daugbjerg P, et al. Diagnostic assessment of haemorrhagic rash and fever. Arch Dis Child 2001;85:160–165.PubMedCrossRef
Nielsen HE, Andersen EA, Andersen J, Bottiger B, Christiansen KM, Daugbjerg P, et al. Diagnostic assessment of haemorrhagic rash and fever. Arch Dis Child 2001;85:160–165.PubMedCrossRef
23.
go back to reference 23 McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG, et al. Observation scales to identify serious illness in febrile children. Pediatrics 1982;70:802–809.PubMed
23 McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG, et al. Observation scales to identify serious illness in febrile children. Pediatrics 1982;70:802–809.PubMed
24.
go back to reference Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J 2007;26:672–677.PubMedCrossRef
Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J 2007;26:672–677.PubMedCrossRef
25.
go back to reference Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics 1990;85:1040–1043.PubMed
Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics 1990;85:1040–1043.PubMed
26.
go back to reference Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003;112:1054–1060.PubMedCrossRef
Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003;112:1054–1060.PubMedCrossRef
27.
go back to reference Galetto-Lacour A, Gervaix A, Zamora SA, Vadas L, Lombard PR, Dayer JM, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr 2001;160:95–100.CrossRef
Galetto-Lacour A, Gervaix A, Zamora SA, Vadas L, Lombard PR, Dayer JM, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr 2001;160:95–100.CrossRef
28.
go back to reference Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics 2006;117:1695–1701.PubMedCrossRef
Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics 2006;117:1695–1701.PubMedCrossRef
29.
go back to reference Almond S, Mant D, Thompson M. Diagnostic safety-netting. Br J Gen Pract 2009;59:872–874.PubMedCrossRef
Almond S, Mant D, Thompson M. Diagnostic safety-netting. Br J Gen Pract 2009;59:872–874.PubMedCrossRef
30.
go back to reference Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997;99:E6.PubMedCrossRef
Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997;99:E6.PubMedCrossRef
31.
go back to reference Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics 2006;118:34–40.PubMedCrossRef
Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics 2006;118:34–40.PubMedCrossRef
32.
go back to reference Berger MY, Boomsma LJ, Albeda FW, Dijkstra RH, Graafmans TA, Van der Laan JR, et al. NHG-Standaard Kinderen met koorts (Tweede herziening). Huisarts Wet 2008:51:287–296.CrossRef
Berger MY, Boomsma LJ, Albeda FW, Dijkstra RH, Graafmans TA, Van der Laan JR, et al. NHG-Standaard Kinderen met koorts (Tweede herziening). Huisarts Wet 2008:51:287–296.CrossRef
Metagegevens
- Titel
- Klinische signalen van ernstige infecties bij kinderen
- Auteurs
-
Ann van den van den Bruel, MD PhD
Tanya Haj-Hassan, BA, MSc
Matthew Thompson, MRCGP, MPH, DPhil
Frank Buntinx, MD PhD
David Mant, FRCGP, FRCP
ERNIE-onderzoekers
- Publicatiedatum
- 01-01-2011
- Uitgeverij
- Bohn Stafleu van Loghum
- DOI
- https://doi.org/10.1007/s12445-011-0010-6