ArticleBMJ (Clinical research ed.)2012
Clinicians' gut feeling about serious infections in children: observational study.
Article in BMJ (Clinical research ed.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05222711 (The Use of a Monitoring Device by General Practitioners During Out-of-hours Care), which is not on this map. Cited by 75 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Use of a Monitoring Device by General Practitioners During Out-of-hours Care: Protocol of a Prospective Randomised Controlled Trial
Who cites it
75 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Understanding the role of GPs' gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Pooled it
- Pooled it
- The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review.Frontiers in pediatrics · 2019Pooled it
- Predicting microbiologically defined infection in febrile neutropenic episodes in children: global individual participant data multivariable meta-analysis.British journal of cancer · 2016Pooled it
- The Practice Guidelines for Primary Care of Acute Abdomen 2015.Japanese journal of radiology · 2016Guideline
- Re-Imagining Clinical Reasoning: An Updated Cognitive Framework for Real-World Medical Practice.Journal of evaluation in clinical practice · 2026Review
- Article
- Physicians' appraisal of parental concerns: a qualitative assessment.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- How To Improve Patient Selection in Individuals With Lower Extremity Amputation Using a Bone-anchored Prosthesis.Clinical orthopaedics and related research · 2025Article
- Prevalence and characteristics of the 'bad feeling' among healthcare professionals in the context of emergency situations: A Bi-Hospital Survey.Journal of clinical nursing · 2025Article
- Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.BJGP open · 2024Article
- A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process.BMC pediatrics · 2024Article
- The linguistic validation of the gut feelings questionnaire in Turkish.The European journal of general practice · 2023Article
- How patients in general practice voice and value their gut feelings about health: a qualitative interview study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Article
- Impact of emotional competence on physicians' clinical reasoning: a scoping review protocol.BMJ open · 2023Article
- Predictive value of clinician impression for readmission and postdischarge mortality among neonates and young children in Dar es Salaam, Tanzania and Monrovia, Liberia.BMJ paediatrics open · 2023Observational
- Article
- Impact of parental and healthcare professional concern on the diagnosis of pediatric sepsis: a diagnostic accuracy study.Frontiers in pediatrics · 2023Article
- ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries.PLOS digital health · 2023Article
- SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.Acta paediatrica (Oslo, Norway : 1992) · 2022Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectiveTo investigate the basis and added value of clinicians' "gut feeling" that infections in children are more serious than suggested by clinical assessment.
designObservational study.
settingPrimary care setting, Flanders, Belgium.
participantsConsecutive series of 3890 children and young people aged 0-16 years presenting in primary care.
main outcome measuresPresenting features, clinical assessment, doctors' intuitive response at first contact with children in primary care, and any subsequent diagnosis of serious infection determined from hospital records.
resultsOf the 3369 children and young people assessed clinically as having a non-severe illness, six (0.2%) were subsequently admitted to hospital with a serious infection. Intuition that something was wrong despite the clinical assessment of non-severe illness substantially increased the risk of serious illness (likelihood ratio 25.5, 95% confidence interval 7.9 to 82.0) and acting on this gut feeling had the potential to prevent two of the six cases being missed (33%, 95% confidence interval 4.0% to 100%) at a cost of 44 false alarms (1.3%, 95% confidence interval 0.95% to 1.75%). The clinical features most strongly associated with gut feeling were the children's overall response (drowsiness, no laughing), abnormal breathing, weight loss, and convulsions. The strongest contextual factor was the parents' concern that the illness was different from their previous experience (odds ratio 36.3, 95% confidence interval 12.3 to 107).
conclusionsA gut feeling about the seriousness of illness in children is an instinctive response by clinicians to the concerns of the parents and the appearance of the children. It should trigger action such as seeking a second opinion or further investigations. The observed association between intuition and clinical markers of serious infection means that by reflecting on the genesis of their gut feeling, clinicians should be able to hone their clinical skills.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.