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American Academy of Pediatrics
Article

Predictive Value of Abnormal Physical Examination Findings in Ill-Appearing and Well-Appearing Febrile Children

Paul L. McCarthy, Robert M. Lembo, Michael A. Baron, Howard D. Fink and Domenic V. Cicchetti
Pediatrics August 1985, 76 (2) 167-171;
Paul L. McCarthy
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Robert M. Lembo
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Michael A. Baron
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Howard D. Fink
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Domenic V. Cicchetti
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Abstract

In order to study the occurrence and positive predictive value of history and physical examination findings suggestive of serious illness in ill-appearing and well-appearing febrile children, 103 consecutive children aged ≤24 months with fever ≥38.3°C were evaluated from July 1, 1982 to Nov 24, 1982. Patients were initially classified by an attending physician (A) as to whether they appeared ill (Yale Observation Scale score >10) or well (scale score ≤10). The history was then taken by two attending physicians (A and B) and a resident; the physical examination was performed by attending physician B and the same resident. As history and physical examination findings were elicited, they were scored as to whether they did or did not suggest a serious illness. Serious illness was defined as the presence of a positive laboratory test. Ill-appearing patients had a significantly greater (P < .001, Fisher's exact test) occurrence of physical examination findings suggesting serious illness (14 of 22, 64%) than well-appearing children (12 of 81, 15%). The positive predictive values of abnormal physical examination findings for serious illness in ill-appearing (11 of 14, 79%) and well-appearing children (3 of 12, 25%) were significantly different (P = .02 by Fisher's exact test). The trends for abnormal history findings in ill-appearing and well-appearing children were similar to those for abnormal physical examination findings but did not achieve statistical significance. The results, indicating an important interaction between a febrile child's appearance and physical examination findings, are discussed in terms of probability reasoning in clinical decision making.

  • fever
  • clinical judgment
  • diagnosis
  • toxicity
  • Bayes theorem
  • Received April 9, 1984.
  • Accepted August 27, 1984.
  • Copyright © 1985 by the American Academy of Pediatrics

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Pediatrics
Vol. 76, Issue 2
1 Aug 1985
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Predictive Value of Abnormal Physical Examination Findings in Ill-Appearing and Well-Appearing Febrile Children
Paul L. McCarthy, Robert M. Lembo, Michael A. Baron, Howard D. Fink, Domenic V. Cicchetti
Pediatrics Aug 1985, 76 (2) 167-171;

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Predictive Value of Abnormal Physical Examination Findings in Ill-Appearing and Well-Appearing Febrile Children
Paul L. McCarthy, Robert M. Lembo, Michael A. Baron, Howard D. Fink, Domenic V. Cicchetti
Pediatrics Aug 1985, 76 (2) 167-171;
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