This document discusses identifying illness in children presenting to emergency care. It notes that while most children will recover without treatment, it can be difficult to determine which children need investigations or antibiotics. The document questions who should decide to investigate a sick child, which tests should be used, and whether test results truly impact decisions around treatment. It seeks input on these challenges and provides resources for further information.

1. Identifying the sick child
A short presentation
Inspired by twitter conversations
Dr. Damian Roland (@damian_roland)
NIHR Doctoral Research Fellow in
Paediatric Emergency Medicine
Paediatric Emergency Medicine Leicester Academic Group
A social enterprise to improve the care of the ill or injured child
Thanks @njoshi8 !

2. A problem…
Children and Infants seeking urgent care
continue to increase
http://adc.bmj.com/content/98/5/328.abstrac
t
Gill Arch Dis Child 2013;98:328-334

3. The majority of children will, even without
treatment, be well.
http://www.ncbi.nlm.nih.gov/pubmed/20406860
Craig BMJ 2010 ; 340:c1594
A conundrum…

4. The low incidence of disease protects the
incompetent
i.e. you can perform poorly consistently and not be
caught out!
BUT…………
A reality…

5. Background

6. Who makes the decision to
Investigate?

7. “What I would really like to know is whether a
procalcitoninlevel 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?

8. “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?

9. The ultimate conundrum
Looks Unwell Looks Well
Investigations: Sepsis Positive
Investigations: Sepsis Negative

10. Thoughts appreciated!
Dr. Damian Roland (dr98@le.ac.uk)
www.rolobotrambles.wordpress.com
www.pemla.com
See
www.spottingthesickchild.com
or free access to a hundreds of video clips
of unwell and well children
Paediatric Observation Priority Score
(available at the app store)