ADC/2009/159095: How well do vital signs identify children with serious infections in paediatric emergency care?

Supplementary tables – suitable for inclusion in website

Table A: Diagnostic characteristics of individual vital signs for identifying children with serious infection vs. intermediate/minor/no infection

Sensitivity
(95% CI) / Specificity
(95% CI) / Positive LR
(95% CI) / Negative LR
(95% CI)
Fever ≥ 39.0oC / 31 (22-40) / 83 (80-86) / 1.9 (1.3-2.6) / 0.8 (0.7-0.9)
Tachypnoea / 65 (56-75) / 55 (51-59) / 1.5 (1.2-1.7) / 0.6 (0.5-0.8)
Tachycardia / 63 (53-72) / 51 (47-55) / 1.3 (1.1-1.5) / 0.7 (0.6-0.9)
CRT > 2 sec / 10 (2-17) / 97 (95-99) / 3.3 (1.2-8.6) / 0.9 (0.8-1.01)
O2 sats ≤ 94% / 30 (21-38) / 90 (88-93) / 3.1 (2.1-4.6) / 0.8 (0.7-0.9)

Notes:

LR = likelihood ratio

CRT = capillary refill time

O2 sats = oxygen saturations

Table B: Comparison of diagnostic characteristics of vital signs, Manchester triage score, and NICE intermediate (amber) or high risk (red) features for identifying children with serious infection vs. intermediate/minor/no infection.

Sensitivity
(95% CI) / Specificity
(95% CI) / Positive LR
(95% CI) / Negative LR
95% CI)
Vital signs:
≥ 1 of fever ≥39oC, O2 sats ≤ 94%, tachycardia, tachypnoea / 86 (79-93) / 34 (30-38) / 1.3 (1.2-1.4) / 0.4 (0.3-0.7)
Manchester triage score:
Urgent/very urgent/emergency
Very urgent/emergency / 89 (83-95)
25 (17-33) / 31 (27-35)
87 (84-90) / 1.3 (1.2-1.4)
1.9 (1.3-2.9) / 0.4 (0.2-0.6)
0.9 (0.8-0.96)
NICE risk features:
≥ 1 intermediate risk (amber) feature
≥ 1 high risk (red) feature
≥ 1 intermediate or high riskfeatures / 86 (80-93)
76 (68-84)
93 (88-98) / 43 (39-47)
45 (41-49)
26 (22-29) / 1.5 (1.4-1.7)
1.4 (1.2-1.6)
1.2 (1.2-1.3) / 0.3 (0.2-0.5)
0.5 (0.4-0.8)
0.3 (0.2-0.6)

Notes:

LR = likelihood ratio

O2 sats = oxygen saturations

Table C): Coding of clinical features and vital signs into NICE traffic light classification

Amber – intermediate risk / Red - high risk
Colour / Pallor (reported by parent) / pallor, flushed, ashen or cyanosed
Activity level / Drowsy, eyes close briefly then awakens, or awakens after prolonged stimulation / Falls asleep when examined, or will not rouse or unconscious, or not alert on AVPU score
Respiratory / Some respiratory distress(e.g. mild recession), or RR >50 (6-12mo) >40 (>12mo), or O2 sats <=95% / Breathing laboured with grunt or nasal flare or marked recession, or RR >60
Hydration / Skin/eyes normal but mouth slightly dry, or CRT>=3sec / Skin doughy or tented. Dry mouth.
Other / Temperature >=39, neck stiffness or non-blanching rash noted

Table D): Association of individual vital signs with hospital admission.

Admitted to hospital for ≥ 1 day
n (%) / Not admitted
or admitted for < 1 day
n (%) / Chi square / Sensitivity / Specificity / LR+ / LR-
Fever ≥ 39.0oC / 60/245
(24.5) / 70/445
(15.7) / 0.005 / 24 / 84 / 1.6 / 0.9
Tachypnoea / 109/206
(52.9) / 178/389 (45.8) / 0.097 / 53 / 69 / 1.7 / 0.7
Tachycardia / 146/246
(59.3) / 205/443 (46.3) / 0.001 / 59 / 54 / 1.3 / 0.8
CRT > 2 sec / 12/136
(8.8) / 4/256
(1.6) / 0.001 / 9 / 98 / 5.7 / 0.9
O2 sats ≤ 94% / 43/242
(17.8) / 42/430
(9.8) / 0.003 / 18 / 90 / 1.8 / 0.9

Notes:

CRT = capillary refill time

O2 sats = oxygen saturation

LR+ = positive likelihood ratio

LR- = negative likelihood ratio

Table E: Frequency of heart rates exceeding centiles for age and temperature in children under 11 years of age

Serious infection
(N = 81)
n (%) / Intermediate infection
(N = 174)
n (%) / Minor infection
(N = 281)
n (%) / Chi square
Heart rate centile for age and temperature / >50th centile / 48/81 (59.3%) / 112/174 (64.4%) / 155/281 (55.2%) / P=0.15
>75th centile / 31/81 (38.3%) / 59/174 (33.9%) / 85/281 (30.2%) / P=0.36
>90th centile / 23/81 (28.4%) / 42/174 (24.1%) / 35/281 (12.5%) / p<0.001
>97th centile / 17/81 (21.0%) / 19/174 (10.9) / 18/281 (6.4%) / P=0.001

Table F: Frequency of intermediate (amber) and high risk (red) NICE clinical risk features in children admitted to hospital

Admitted to hospital (N=250)
n (%) / Not admitted
or admitted for < 1 day
(N=450)
n (%)
Amber features:
0
1
2
≥3 / 69 (27.6)
102 (40.8)
53 (21.2)
26 (10.4) / 203 (45.1)
178 (39.6)
58 (12.9)
11 (2.4)
Red features:
0
1
2
≥3 / 84 (33.6)
119 (47.6)
44 (17.6)
3 (1.2) / 208 (46.2)
194 (43.1)
45 (10.0)
3 (0.7)
Any amber or red features:
0
1
2
3
≥5 / 41 (16.4)
57 (22.8)
67 (26.8)
46 (18.4)
39 (15.6) / 118 (26.2)
144 (32.0)
113 (25.1)
54 (12.0)
21 (4.7)