The conundrum of spotting the sick child

A discussion, rather than a presentation, of thoughts on the complexity of "spotting the sick child". More for promotion of discussion rather than education.

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.abstract 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 procalcitonin level 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 ( [email protected] ) www.rolobotrambles.wordpress.com www.pemla.com See www.spottingthesickchild.com for free access to a hundreds of video clips of unwell and well children Paediatric Observation Priority Score (available at the app store)