Dissertation on the Role of Symptoms and Intuitive Assessment in the Diagnosis of Severe Bacterial Infections in Children with Fever

Fever, or high temperature in a child, is one of the most common reasons for parents seeking medical help. Most commonly, fever in children is caused by self-limiting viral infections, but in a small number of children, the fever can be caused by severe bacterial infections that require more thorough examination and early treatment with antibiotic drugs.

The main aim of the study was to find out how to make early and effective assessments of the likelihood of a child having a severe bacterial infection during a high patient flow. The diagnostic value of different symptoms and signs of a child’s illness, doctors’ intuitive assessment of a possible severe illness of the child, and parental concerns that a child's illness has a different, more severe course, in recognising severe bacterial infections at a time when clinical examination results are not yet available, was studied. The reasons for parental anxiety in cases of fever were also explored through questionnaires and interviews.

As part of the doctoral thesis, an assessment tool or clinical prediction model for children with fever was created to be used in Emergency Departments to help determine the likelihood of severe bacterial infections. It was proved that adding a physician's intuitive assessment to the model, where the assessment of the child is based on a selected set of key clinical signs, significantly improved its effectiveness in diagnosing severe infections.

The study into the reasons for parental concern showed that while many parents were concerned about the signs of their child's illness, which are also associated with a high risk of severe infections in various clinical studies, the high temperature of the child itself was a significant reason for parental concern. It was widely believed that fever in itself was an indication of serious illness, and various adverse side-effects were attributed to fever, including febrile seizures, damage to the brain, lungs, kidneys and other organs, and even death. Parents' perceptions of fever also influenced their habits in seeking medical help, encouraging worried parents to seek medical help earlier and to give their child antipyretic medication if the temperature was even slightly elevated. Parents' anxiety was affected by gaps in communication with medical staff, such as receiving incomplete explanations about the reasons for the high temperature. To obtain reliable results on the importance of parental concerns in the diagnosis of severe infections in children with fever, educational work is needed to reduce the so-called “fever phobia”.

Urzula Nora Urbane defended her doctoral thesis “Diagnostic Value of Clinical Presentation, Parental Concern, and Clinician’s Non-Analytical Reasoning in Identifying Serious Bacterial Infections in Febrile Children” on 2 September 2022.

Further information

Doctoral thesis supervisors: Assoc.Prof. Jana Pavāre (RSU) and Assoc. Prof. Dace Zavadska (RSU)

RSU dissertation database