April 21, 2010 by Jennifer Trueland
Computers are better than doctors at diagnosing serious bacterial infection – such as meningitis – in young children, according to a study published today.
Children, especially those under five years old, commonly have fever or febrile illness, but it can be difficult to ascertain the cause.
This can be vital because doctors have to be able to tell whether a child is suffering from a minor viral illness, or a serious bacterial infection, such as pneumonia, meningitis or a urinary tract infection.
Getting it wrong and failing to diagnose a serious infection and delaying treatment can be fatal – but diagnosing one where it isn’t there can result in children being prescribed antibiotics unnecessarily.
Researchers in Australia developed a computerised model to distinguish between serious bacterial infections and self-limiting non-bacterial illnesses.
The study included more than 15,000 healthy children aged under five who attended the emergency department of a large children’s hospital with a fever (defined as a body temperature of 38C or more in the previous 24 hours).
Doctors performed the usual clinical evaluation and serious bacterial infections were confirmed or otherwise by using standard tests. The signs and symptoms seen by the physicians were combined in a diagnostic model, which was compared to what actually happened in clinical practice.
The data show that of the seven per cent of children who were later confirmed as having a bacterial infection, only 70-80 per cent were prescribed antibiotics at the initial consultation. Conversely, around a fifth of those who were not subsequently confirmed as having an identified bacterial infection were probably given antibiotics when they shouldn’t have been.
In each infection – urinary tract, pneumonia and bacteraemia (bacteria in the blood) the diagnostic model out-performed or was as good as evaluation by a doctor.
Writing in the BMJ, the authors, including Jonathan Craig of the University of Sydney, point out that almost all (95%) of these children had the appropriate tests and that some doctors routinely delay giving antibiotics until test results are known, so this may help to explain the initial under-treatment. However, about two thirds of children who were not treated were subsequently prescribed antibiotics.
They conclude: “By combining routinely collected clinical information into a statistical model, we have demonstrated that a clinical diagnostic model may improve the care of children presenting with fever who have suspected serious bacterial illness.”
Click the link to read the rest of the article about computers are ‘better than doctors’
Click the link to read the full study in the BMJ about the accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection