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A discussion, rather than a presentation, of thoughts on the complexity of "spotting the sick child". More for promotion of discussion rather than education.
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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 ([email protected])
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)