When and how do GPs record vital signs in children with acute infections? A cross-sectional study

Abstract

Background: NICE recommendations and evidence from ambulatory settings promotes the use of vital signs in identifying serious infections in children. This appears to differ from usual clinical practice where GPs report measuring vital signs infrequently.

Aim: To identify frequency of vital sign documentation by GPs, in the assessment of children with acute infections in primary care.

Design and setting: Observational study in 15 general practice surgeries in Oxfordshire and Somerset, UK.

Method: A standardised proforma was used to extract consultation details including documentation of numerical vital signs, and words or phrases used by the GP in assessing vital signs, for 850 children aged 1 month to 16 years presenting with acute infection.

Results: Of the children presenting with acute infections 31.6% had one or more numerical vital signs recorded (269, 31.6%), however GP recording rate improved if free text proxies were also considered: at least one vital sign was then recorded in over half (54.1%) of children. In those with recorded numerical values for vital signs, the most frequent was temperature (210, 24.7%), followed by heart rate (62, 7.3%), respiratory rate (58, 6.8%), and capillary refill time (36, 4.2%). Words or phrases for vital signs were documented infrequently (temperature 17.6%, respiratory rate 14.6%, capillary refill time 12.5%, and heart rate 0.5%), Text relating to global assessment was documented in 313/850 (36.8%) of consultations.

Conclusion: GPs record vital signs using words and phrases as well as numerical methods, although overall documentation of vital signs is infrequent in children presenting with acute infections.

Figure 1

Proportion of children in whom one or more vital sign was recorded at consultation.

Figure 2

Frequency of text recording only relating to vital signs compared to numerically recorded vital signs by GPs.

Figure 3

Frequency (%) of documentation of global assessment by GPs in 850 children with symptoms of acute infection.