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GPs should listen to gut instincts when assessing children, research finds

GPs should listen to their gut instincts when assessing poorly children, say researchers who have proven its value in spotting serious illness.

Researchers at the University of Oxford studied data from 3890 children who presented first to their GPs, looking at presenting features, clinical assessment and any subsequent diagnosis of serious infection. But they were also able to analyse the GP’s gut feeling at the time- defined as an intuitive feeling that something was wrong even if the clinician was unsure why.

Of those children that were clinically assessed as having a non-severe illness, 0.2% were subsequently admitted with a serious infection including meningitis, sepsis, pneumonia  or pyelonephritis.

But a GP’s intuition that something was wrong was more than 25 times more likely to be recorded in the notes of one of these children.

Acting on the gut feeling would have spotted two of six missed cases of severe illness, such as meningitis or sepsis, at a cost of 44 false alarms, researchers found.

Picking up on parents concern that something was unusually wrong was a strong factor in clinicians’ gut reaction that the illness could be more serious than it seemed to appear, they report in the BMJ.

Study leader Dr Ann Van den Bruel, clinical lecturer at the department of primary care health sciences at the Radcliffe Observatory Quarter in Oxford said while it would be unfeasible for GPs to send all children to A&E if their gut is telling them something is not right they should allow for a higher threshold of concern.

‘Doctors need to be aware of it and be sensitive to when they have that “gut feeling”,’ she said.

‘When they feel it, they firstly need to be very careful in their clinical examination.

‘As a second step they could ask the opinion of someone else, maybe another more experienced GP or a paediatrician, and third if they don’t find any reason for referral, they should make sure the parents know what to do if things get worse.’

Clinical factors associated with ‘gut feeling’ were general appearance, breathing pattern, weight loss and history of convulsions but temperature was not found to be linked to a intuition that something was wrong.

To their surprise, the researchers found that instinct was not related to the experience of the clinician.

Dr Sonia Saxena, a GP and clinical senior lecturer in the department of primary care and public health at Imperial College London, said that gut feeling has the potential to identify a number of missed serious infections in children because ‘it is a proxy marker for the complex formulation that an experienced clinician can create when faced with lots of sensory information’.

She said this is particularly true of those working in primary care who often see children before they are unwell and through minor illnesses.

‘We also have the opportunity to observe how families cope when their child is unwell,’ she added.

 

Signs linked to a GP’s gut feeling

Strongly linked:

History of convulsions

Parental concerns

The child’s appearance

Breathing pattern

Level of drowsiness

Not linked:

Temperature

History of cough

Diarrhoea

Readers' comments (3)

  • Dear Paeds SHO "I'm just not happy"

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  • the figures presented are correct, but the devil is in the detail:
    To quote the paper: “. The clinical features most strongly associated with gut feeling were the children’s overall response (drowsiness, no laughing), abnormal breathing, weight loss, and convulsions.”… convulsions!!!

    Yep that would raise my gut feeling too!!!!!!¬!

    Not really representative of GP assessment I feel.

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  • Vinci Ho

    It is easy to sit down to do a retrospective descriptive study from academics. Every case is different , that gut feelings matter when definitive symptoms and signs are absent or inconsistently present . That 's why experiences are so important .
    The other point is whether the referral is 'appropriate' or not . The figures generated to bureaucrats will bite back on GP as the current obssession of cutting hospital admissions continues.
    If you want to be safe handling children , you have to exclude these 'suspected to be serious' cases even when they turn out to be negative. But I am afraid bureaucrats are not interested as cutting cost is the only aim..........

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