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Authors: Thompson, Matthew¹; Mayon-White, Richard¹; Harnden, Anthony¹; Perera, Rafael¹; McLeod, Diane¹; Mant, David¹

Source: British Journal of General Practice, Volume 58, Number 549, April 2008 , pp. 236-241(6)

Abstract:

Background

GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known.

Aim

To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections.

Design of study

Questionnaire survey.

Setting

All 210 GP principals working within a 10 mile radius of Oxford, UK.

Method

Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness.

Results

One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness.

Conclusion

Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.

Keywords: body temperature; child; heart rate; infection; observation; triage

Document Type: Research article

DOI: 10.3399/bjgp08X279689

Affiliations: 1: Oxford University Department of Primary Health Care, Oxford

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