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New model could improve fever diagnosis and treatment

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Early treatment of fever in young children may be improved by a computerised diagnostic model that outperforms clinical judgement, according to a study published on bmj.com.

It can be difficult to diagnose the cause of fever, or febrile illness, in young children, even though it is a common symptom. Physicians need to distinguish between a minor viral illness and a serious bacterial infection, such as urinary tract infection, meningitis or pneumonia. Clinical scoring systems and current diagnostic processes can often prove to be inadequate.

More than 15,000 healthy children under five were involved in a study in Australia designed to develop and test a computerised model to distinguish between serious bacterial infections and self limiting non-bacterial illnesses. The children all came to the emergency department of a children’s hospital over a two-year period with a febrile illness.

A standard clinical evaluation was performed by physicians and serious bacterial infections were confirmed or excluded using standard tests and follow-up. The signs and symptoms noted by the physicians were then combined in a diagnostic model and the results were compared.

The data shows that urinary tract infection, pneumonia and bacteraemia (bacteria in the blood) occur in about 7% of young children with a fever, but only 70-80% of these children are prescribed antibiotics on initial consultation and 20% of children without an identified bacterial infection are probably over-treated with antibiotics.

The performance of the diagnostic model for each infection was acceptable or better than physician evaluation.

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