Diagnosing serious bacterial infection in young febrile children

.In the linked prospective cohort study (doi:10.1136/bmj.c1594), Craig and colleagues present new evidence to guide clinicians who assess children with acute infections.1 Young children often attend emergency departments and primary care with acute infections.2 Most of these infections are self limiting, yet identifying the small proportion of children who have a serious or life threatening infection can be challenging and a source of great anxiety for parents.3 Although routine childhood vaccinations have decreased the incidence of serious bacterial infection (currently 1% in primary care, 20% in emergency departments), the consequences of misdiagnosing the most serious infections can be dire.4 5

We have reasonably good evidence for the diagnostic value of clinical features for conditions such as pneumonia and to a lesser extent meningitis,6 but for others such as urinary tract infections, we know little about which clinical features predict serious outcome.7 However, because children do not always present with discrete clinical conditions, more generic tools have been developed to identify those at greatest risk of serious illness. Some such as the Yale score have fallen from use, others such as the Manchester triage system have …