Excluding serious illness in feverish children in primary care: restricted rule-out method for diagnosis

doi:10.1136/bmj.b1187

Published 20 April 2009, doi:10.1136/bmj.b1187
Cite this as: BMJ 2009;338:b1187

Practice

Diagnosis in General Practice

Excluding serious illness in feverish children in primary care: restricted rule-out method for diagnosis

Matthew J Thompson, senior clinical scientist and general practitioner¹, Anthony Harnden, university lecturer¹, Chris Del Mar, dean²

¹ Department of Primary Health Care, University of Oxford, England, ² Faculty of Health Sciences and Medicine, Bond University, Australia

Correspondence to: M J Thompson matthew.thompson@dphpc.ox.ac.uk

Two children presenting to general practice with fever showhow general practitioners use restricted rule-out, one of thestrategies to make a diagnosis set out by Heneghan and colleagues(doi:10.1136/bmj.b946)

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

Consider two common scenarios in primary care.

Child 1: A mother calls the out of hours service in the earlyevening about her 3 year old son. He was seen earlier in theweek with cough and runny nose, and the general practitioner(GP) diagnosed an upper respiratory tract infection. He hasbeen getting more miserable and irritable, is lying on the sofareluctant to move, looks "washed out," and has a fever. Hismother is worried: "Could it be meningitis, doctor?"

Child 2: A 2 year old girl is brought to your morning surgerywith a history of a fever that started during the night. Youhave already seen several children this morning with a non-specificbut seemingly mild viral illness.

The list of possible diagnoses for febrile children seen inprimary care is long. Identifying children who may have a seriousillness can be difficult and is at . . . [Full text of this article]

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Research is needed in the natural course of fever and its spatial distribution throughout the body over time.: Wouter Havinga
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