Red Flags May Help Identify Serious Infection in Children

From MedscapeCME Clinical Briefs
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

February 11, 2010 — Rapid breathing, parental concern, and the clinician's instinct are among the red flags warning of serious infection in children in developed countries, according to the results of a systematic review reported online in the February 3 issue of The Lancet.

Clinical Context

The World Health Organization has defined some criteria as red flags for serious infection in children in developing countries. These include reduced consciousness, convulsions, cyanosis, rapid breathing, and low capillary refill. However, in the United Kingdom, serious infection accounts for 20% of deaths in children, but in a primary care setting, only 1% of children assessed will have a serious illness.

This is a systematic review of studies to examine the clinical features most useful for ruling in and ruling out serious infection in children in developed countries.

Clinical Implications

Parental concern and clinician instinct followed by cyanosis, rapid breathing, poor peripheral circulation, and petechial rash are predictive of serious infection in children.
Absence of parental or clinician concern and absence of breathlessness are helpful for ruling out pneumonia in children.