Evidence map›Paper›PMID 26254472›Full record

ArticleBMJ open2015

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.

Jan Y Verbakel, Marieke B Lemiengre, Tine De Burghgraeve, An De Sutter, Bert Aertgeerts, Dominique M A Bullens, Bethany Shinkins, Ann Van den Bruel, Frank Buntinx

Registry-linked trialAbstract readMulticenter StudyValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02024282 (Validation of a Vital Signs and Symptoms Decision Tree and the Effect of a Point-of- Care CRP Test, Oxygen Saturation, a Brief Intervention and a Parent Leaflet on Diagnosing, Antibiotic Prescribing Rate and Parental Satisfaction in Acutely Ill Children in Primary Care."), which is not on this map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT02024282 nacompletednot on this map

Validation of a Vital Signs and Symptoms Decision Tree and the Effect of a Point-of- Care CRP Test, Oxygen Saturation, a Brief Intervention and a Parent Leaflet on Diagnosing, Antibiotic Prescribing Rate and Parental Satisfaction in Acutely Ill Children in Primary Care."

TypeinterventionalSponsorKU LeuvenRan2013 to 2014Enrolled8,962ConditionsSepsis, Bacteraemia, Meningitis, AbscessArmsUse of C-reactive protein (CRP) point of care test, Brief intervention and parent leaflet, Finger Pulse Oximeter
3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
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  6. Article
  7. Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Article
  8. Article
  9. Identifying serious bacterial illness in children: is it time to show the red card to NICE's red flags?The British journal of general practice : the journal of the Royal College of General Practitioners · 2023
    Article
  10. Observational
  11. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jan Y VerbakelDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Marieke B LemiengreDepartment of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
Tine De BurghgraeveDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
An De SutterDepartment of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
Bert AertgeertsDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Dominique M A BullensClinical Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium Paediatric Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
Bethany ShinkinsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ann Van den BruelNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Frank BuntinxDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium Research Institute Caphri, Maastricht University, Maastricht, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveAcute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population.

designDiagnostic accuracy study validating a clinical prediction rule. SETTING AND

participantsAcutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department.

interventionPhysicians were asked to score the decision tree in every child. PRIMARY OUTCOME MEASURES: The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values.

resultsIn total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%.

conclusionsIn an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. TRIAL REGISTRATION NUMBER: NCT02024282.

Indexed as

Decision Support TechniquesDecision TreesAcute DiseaseAdolescentAmbulatory CareBelgiumChildChild, PreschoolFemaleHumansInfantInfectionsMaleProspective StudiesSensitivity and SpecificityACCIDENT & EMERGENCY MEDICINEEPIDEMIOLOGYPRIMARY CARE

Identifiers

PMID26254472
PMCPMC4538259

What OpenQuestion holds

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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.