Clinical markers of serious illness in young infants: A multicentre follow-up study

Objective: To perform a multicentre follow-up study to determine if previou sly identified markers of serious illness in early infancy were robust and statistically reliable. Methods: Infants aged 1 week to 26 weeks presenting to the Emergency Depart ments of the Royal Children's Hospital and two Melbourne metropolitan hospi tals were seen over a 12-month period. Eleven clinical markers as well as t heir temperature were documented by nursing staff and resident medical offi cers. Serious illness was defined if infants had a positive body fluid bact erial culture, a positive chest X-ray or if significant treatment was requi red in hospital. The predictive values, sensitivity and specificity for the individual and the best combination of clinical markers were determined. Results: Assessments (3806) were performed with 312 infants being assessed as seriously ill (8.2%). The combination of either drowsiness on history or examination, pallor on history or examination, breathing difficulty (chest wall recession), temperature above 38 degrees C and a lump being present, identified 82.5% of all babies deemed subsequently to be seriously ill. The positive predictive value of an infant who was febrile, drowsy and pale on examination was 70.7% (previous study 74%). Conclusions: This study confirmed the high individual predictive value of a rousal variables, pallor, and chest wall recession, especially when associa ted with fever, reaffirming their utility in the recognition of serious ill ness in infants under 6 months of age.