• M Thompson, N Coad, A Harnden, R Mayon-White, R Perera, and D Mant.
• Department of Primary Health Care, Oxford University, Oxford, UK. matthew.thompson@dphpc.ox.ac.uk
• Arch. Dis. Child. 2009 Nov 1;94(11):888-93.

ObjectivesTo determine whether vital signs identify children with serious infections, and to compare their diagnostic value with that of the Manchester triage score (MTS) and National Institute for Health and Clinical Excellence (NICE) traffic light system of clinical risk factors.DesignProspective cohort of children presenting with suspected acute infection. We recorded vital signs, level of consciousness, activity level, respiratory distress, hydration and MTS category.SettingPaediatric assessment unit at a teaching hospital in England.Participants700 children (median age 3 years), of whom 357 (51.0%) were referred from primary care, 198 (28.3%) self-referrals and 116 (16.6%) emergency ambulance transfers. Just over half (383 or 54.7%) were admitted.Main Outcome MeasuresSeverity of infection categorised as serious, intermediate, minor or not infection.ResultsChildren with serious or intermediate infections (n = 313) were significantly more likely than those with minor or no infection (n = 387) to have a temperature >or=39 degrees C, tachycardia, saturations 2 seconds. Having one or more of temperature >or=39 degrees C, saturations ConclusionsA combination of vital signs can be used to differentiate children with serious infections from those with less serious infections in a paediatric assessment unit and has comparable sensitivity to more complicated triage systems. The diagnostic value of combined vital signs and the NICE traffic light system remains to be determined in populations where the prevalence of severe illness is much lower.

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