Vital signs, clinical rules, and gut feeling: an observational study among patients with fever
| Autor: | Jean W M Muris, Lieke Claassen, Patricia M. Stassen, Gideon H. P. Latten, Vera Goedemondt, Jochen W L Cals, Lucinda Coumans, Calvin Brouwer |
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| Přispěvatelé: | Family Medicine, RS: CAPHRI - R5 - Optimising Patient Care, Family Medicine Education, MUMC+: MA Alg Interne Geneeskunde (9), Interne Geneeskunde |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Medicine (General) hospital referrals Referral Sequential organ failure assessment business.industry media_common.quotation_subject Vital signs Emergency department medicine.disease vital signs Systemic inflammatory response syndrome emergency service hospital R5-920 Feeling general practitioners Emergency medicine medicine infectious illness Observational study In patient Family Practice business media_common |
| Zdroj: | BJGP Open, Vol 5, Iss 6 (2021) BJGP Open, 5(6). Royal College of General Practitioners |
| ISSN: | 2398-3795 |
| Popis: | BackgroundGPs decide which patients with fever need referral to the emergency department (ED). Vital signs, clinical rules, and gut feeling can influence this critical management decision.AimTo investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling.Design & settingProspective observational study at two out-of-hours (OOH) GP cooperatives in the Netherlands.MethodDuring two 9-day periods, GPs performed their regular work-up in patients aged ≥18 years with fever (≥38.0°C). Subsequently, researchers measured missing vital signs for completion of the systemic inflammatory response syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score. Associations between the number of referrals, positive SIRS and qSOFA scores, and GPs’ gut feelings were investigated.ResultsGPs measured and recorded all vital signs required for SIRS criteria and qSOFA score calculations in 24 of 108 (22.2%) assessed patients, and referred 45 (41.7%) to the ED. Higher respiratory rates, temperatures, clinical rules, and gut feeling were associated with referral. During 7-day follow-up, nine (14.3%) of 63 patients who were initially not referred were admitted to hospital.ConclusionGPs measured and recorded all vital signs for SIRS criteria and qSOFA score in one-in-five patients with fever, and referred half of 63 patients who were SIRS-positive and almost all of 22 patients who were qSOFA-positive. Some vital signs and gut feeling were associated with referral, but none were consistently present in all patients who were referred. The vast majority of patients who were not initially referred remained at home during follow-up. |
| Databáze: | OpenAIRE |
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