Face to face always

doi:10.1136/bmj.39332.422801.3A

BMJ 2007;335:527 (15 September), doi:10.1136/bmj.39332.422801.3A

Letters

Spotting the sick child

Face to face always

The first 150 words of the full text of this article appear below.

Performing snapshot assessments in emergency settings, wheretime is precious, is notoriously risky. Serial assessment ofthe child is best but not always possible. A scientific approachof measuring heart rate, capillary refill, respiratory rate,and behaviour takes less than 3 minutes¹ and is achievable inthese settings. Harnden is wrong in saying that this is notachievable in primary care.² To state that there is no evidencethat measurement of these parameters helps identify seriousbacterial illness may be true for primary care but is not truein hospital (emergency department or paediatric wards). Lackof evidence of association is not evidence of lack of association,so logic dictates that a similar assessment should take placein primary care.

The Intercollegiate Advisory Group for Services for Childrenin Emergency Departments has concerns about the abilities oftelephone triage systems and inadequately trained frontlinestaff to differentiate seriously ill children . . . [Full text of this article]

Ffion C Davies, consultant in emergency medicine

Leicester Royal Infirmary, Leicester LE1 5WW

Ffion.davies@uhl-tr.nhs.uk