28 September 2012

Doctors' intuition may be key

Physicians should pay attention to their 'gut feeling' to detect serious illness in children.


Doctors who have a gut feeling about a serious infection in a child should take action on that intuition, according to a new study.

In young children, serious infection is often hard to diagnose and can be "like finding a needle in a haystack", according to background information in the report, which was published online in the journal BMJ. A doctor's intuition that something is seriously wrong may have more diagnostic value than many symptoms and signs, the report suggested.

For the study, researchers in England and Belgium looked at nearly 3 900 children aged 16 and younger in Belgium, who were assessed by primary care doctors in 2004. Of those children, 21 were later admitted to the hospital with a serious infection. Nine of those 21 were not referred for further care after the initial primary care assessment, even though the doctor confessed that they had a feeling that something was wrong in four of the nine cases.

A child's history of convulsions and overall appearance and breathing were the features most strongly associated with doctors having a feeling that there might be a serious infection. Parental concern that a child's illness was different than normal was another strong influence on gut feeling, the study authors noted in a journal news release.

The investigators also found that less-experienced doctors reported having a gut feeling more often than more senior doctors. But the diagnostic power of a gut feeling was no better in experienced than non-experienced doctors.

Medical teaching should make clear that an "inexplicable gut feeling is an important diagnostic sign and a very good reason for seeking the opinion of someone with more paediatric expertise or performing additional testing," said study author Ann Van den Bruel, of the University of Oxford in England, and colleagues.

A gut feeling should prompt doctors to conduct a full and careful examination, seek advice from a more experienced doctor, and advise parents what to do if their child's condition worsens, the researchers concluded.

(HealthDay, September 2012)

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