Vital signs, clinical rules, and gut feeling: an observational study among patients with fever

BJGP Open

Jochen WL Cals¹  Jean WM Muris¹  Patricia M Stassen²  Lieke Claassen³  Gideon HP Latten³  Calvin Brouwer³  Vera Goedemondt³  Lucinda Coumans³ 

[1] Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands;Department of Internal Medicine, Division General Medicine, Section Acute Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands;Emergency Department, Zuyderland Medisch Centrum, Heerlen, The Netherlands;

关键词: infectious illness;    hospital referrals;    vital signs;    emergency service, hospital;    general practitioners;   

DOI  :  10.3399/BJGPO.2021.0125

来源: DOAJ

【 摘 要 】

Background: GPs 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. Aim: To investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling. Design & setting: Prospective observational study at two out-of-hours (OOH) GP cooperatives in the Netherlands. Method: During 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. Results: GPs 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. Conclusion: GPs 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.

【 授权许可】

Unknown