Sepsis and meningitis in hospitalized children: performance of clinical signs and their prediction rules in a case-control study.

Objective: Feverish illness is a common presentation to acute pediatric services. Clinical staff faces the challenge of differentiating the few children with meningitis or sepsis from the majority with self-limiting illness. We aimed to determine the diagnostic value of clinical features and their prediction rules (CPR) for identifying children with sepsis or meningitis among those children admitted to a District General Hospital with acute febrile illness.

Risk score to stratify children with suspected serious bacterial infection: observational cohort study.

Objectives: To derive and validate a clinical score to risk stratify children presenting with acute infection.

Study Design And Participants: Observational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome.

Evaluation of temperature-pulse centile charts in identifying serious bacterial illness: observational cohort study.

Background: Distinguishing serious bacterial infection (SBI) from milder/self-limiting infections is often difficult. Interpretation of vital signs is confounded by the effect of temperature on pulse and respiratory rate. Temperature-pulse centile charts have been proposed to improve the predictive value of pulse rate in the clinical assessment of children with suspected SBI.

An evidence-based guideline for children presenting with acute breathing difficulty.

Objective: The aim of this study was to develop an evidence-based guideline for use primarily by junior clinicians to assist with the management of children presenting to the hospital with an acute breathing difficulty.

Methods: An overview of the literature provided a framework of clinical questions for the management of a child with an acute breathing difficulty on which to base a systematic literature review. Relevant articles were appraised by the research fellow and graded according to their quality.

The impact of presenting problem based guidelines for children with medical problems in an accident and emergency department.

Aims: To evaluate the impact of presenting problem based guidelines in managing children with either diarrhoea (with or without vomiting) or seizure (with or without fever).

Methods: This prospective observational study with an intervention was based on a paediatric accident and emergency (A&E) department in Nottingham. All patients (either GP or self referred) were acute attenders aged 0-15 years, with a medical presenting problem during 4 months in the spring of 1997 and 1999.

An evidence and consensus based guideline for the management of a child after a seizure.

Objective: An evidence and consensus based guideline for the management of the child who presents to hospital having had a seizure. It does not deal with the child who is still seizing. The guideline is intended for use by junior doctors, and was developed for this common problem (5% of all paediatric medical attenders) where variation in practice occurs.

Recent trends in hospital use by children in England.

Background: Routine hospital statistics for England appear to overestimate use of children's wards and include numbers of well newborn babies staying with their mothers after delivery ("well babies").

Aim: To review trends in use of children's wards excluding data on newborn babies.

Methods: We reviewed routine, published, and age stratified data requested from the Department of Health to identify separately "well babies" and babies receiving neonatal specialist care from admissions (surgical and paediatric) to children's wards.

An evidence and consensus based guideline for acute diarrhoea management.

Objective: To develop an evidence and consensus based guideline for the management of the child who presents to hospital with diarrhoea (with or without vomiting), a common problem representing 16% of all paediatric medical attenders at an accident and emergency department. Clinical assessment, investigations (biochemistry and stool culture in particular), admission, and treatment are addressed. The guideline aims to aid junior doctors in recognising children who need admission for observation and treatment and those who may safely go home.

Determining the common medical presenting problems to an accident and emergency department.

All accident and emergency (A&E) attendances over a one year period were prospectively studied in order to determine common medical presenting problems. Data were collected on children (0-15 years) attending a paediatric A&E department in Nottingham between February 1997 and February 1998. A total of 38 982 children were seen.

Accounting for overlap? An application of Mezzich's kappa statistic to test interrater reliability of interview data on parental accident and emergency attendance.

Study Rationale: The number of interview studies with service users is rising because of growth in health services research. The level of agreement between multiple interview data coders requires statistical calculation to support results. Basic kappa statistics are often used but this depends on having mutually exclusive data.

Clinical training experience in district general hospitals.

Aims: To estimate the nature and quantity of clinical experience available for trainees in paediatrics or general practice in acute general hospitals of differing sizes in the UK. To discuss implications for training and service configuration taking account of current Royal College recommendations (a minimum of 1,800 acute contacts each year and ideally covering a population of 450,000 to 500,000 people).

Methods: Observed frequencies of diagnoses in Pinderfields Hospital, Wakefield were compared with those in five other hospitals in Yorkshire and four in the South of England, and with expected frequencies from a review of selected marker conditions using national routine and epidemiological data.

Generalised uridine diphosphate galactose-4-epimerase deficiency.

The generalised form of epimerase deficiency galactosaemia has been described in only two children from unrelated families. Their progress is reported and three other affected children from these families are described. The initial presentation was similar to classic galactosaemia.

Medical and social factors associated with the admission and discharge of acutely ill children.

Aim: To examine medical and sociodemographic factors involved in acute paediatric admission. To compare outcome of admission with factors present at time of admission.

Methods: Prospective questionnaire based study of 887 consecutive emergency general paediatric admissions to five Yorkshire hospitals during two separate three week periods in summer and winter.

Parental and professional perception of need for emergency admission to hospital: prospective questionnaire based study.

Aim: To compare views of parents, consultants, and general practitioners on severity of acute illness and need for admission, and to explore views on alternative services.

Method: Prospective questionnaire based study of 887 consecutive emergency paediatric admissions over two separate three week periods in summer and winter of five Yorkshire hospitals, combined with a further questionnaire on a subsample.

Outcome Measures: Parental scores of need for admission and parent and consultant illness severity scores out of 10.

Validation of the paediatric appropriateness evaluation protocol in British practice.

The reliability and validity of the North American paediatric appropriateness evaluation protocol (PAEP) for use in paediatric practice in Britain was tested. The protocol was applied to 418 case records of consecutive emergency admissions to three Yorkshire district general hospitals. The PAEP ratings were then compared with a clinical consensus opinion obtained from two expert panels.

The management of pyloric stenosis in a district hospital.

Over a 10-year period, 80 infants were admitted with a diagnosis of pyloric stenosis. Seventy-nine underwent surgical pyloromyotomy (63 male, 16 female; mean age 5.6 weeks).

Appropriateness of paediatric admission.

A study of the 'appropriateness' of 267 consecutive emergency admissions to a district paediatric department showed that admission was at a peak in the evening and night time. Breathing difficulty, head injury, and fever were the commonest presenting problems. Sixty three per cent of admissions occurred between 6 pm and 8 am and these were more likely to be after self referral to the accident and emergency department and were evenly distributed through the social classes.

Paediatric inpatient utilisation in a district general hospital.

Paediatric inpatient utilisation in a district general hospital was studied for 20 general practices covering a population of 26,433 children. The factors influencing the rate and route of admission (general practitioner (GP) or accident and emergency department) were analysed for 894 emergency non-traumatic admissions over a 12 month period. The overall rate of acute, nontraumatic admission was 33.

Paediatric outpatient utilisation in a district general hospital.

Paediatric outpatient utilisation in a district general hospital was studied for 20 general practices that covered a population of 26,433 children. The actions taken by paediatric staff were analysed for 487 new referrals and 2784 review attendances (the latter in 1630 children) over an eight month period. New referral rates from different general practices varied between 3.