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Thompson M, Van den Bruel A, Verbakel J, et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Southampton (UK): NIHR Journals Library; 2012 Mar. (Health Technology Assessment, No. 16.15.)

Appendix 2Details of the clinical prediction rules identified in the systematic review

Name of clinical prediction ruleClinical featuresDerivation study
All serious infections
YOSQuality of cryReaction to parents' stimulationState variationColourHydrationResponse to social overturesMcCarthy et al.36
ValuesStrong OR not crying 1Cries briefly 1Stays awake 1Pink 1Skin normal 1Smiles OR alerts 1
Whimpering 3Cries off and on 3Awakes with stimulation 3Pale extremities 3Dry mouth 3Brief smile OR alerts briefly 3
Weak 5Continual cry 5Falls to sleep 5Pale OR cyanotic 5Skin doughy 5No smile OR face anxious 5
Calculate the sum of all six feature values (cut-offs used in literature: 8, 9 or 10)
Five-stage decision treeClinician instinct that something is wrongDyspnoeaTemperature > 39.95 °CDiarrhoeaAge 15–25 monthsVan den Bruel et al.11
ValuesNo 0No or unknown 0< 39.95 °C 0No or unknown 0No or unknown 0
Yes or unknown 1Yes 1> 39.95 °C 1Yes 1Yes 1
If yes to any of these five features
Pneumonia
Pneumonia rule no. 1Parental concern illness is differentShortness of breathVan den Bruel et al.11
ValuesIf yes to any of these two features
Pneumonia rule no. 2Clinician concern illness is differentShortness of breathVan den Bruel et al.11
ValuesIf yes to any of these two features
Meningitis
Meningitis rule no. 1Any abnormal neurological findingSought care < 48 hoursOffringa et al.71
ValuesIf yes to any of these two features
Meningitis rule no. 2PetechiaeNuchal rigidityComaJoffe et al.70
ValuesIf yes to any of these three features
Gastroenteritis with dehydration
Gastroenteritis rule no. 1Absent tearsDry mucous membranesIll appearancePoor peripheral circulationGorelick et al.68
ValuesIf yes to any two of these four features
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Cover of Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care
Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care.
Health Technology Assessment, No. 16.15.
Thompson M, Van den Bruel A, Verbakel J, et al.
Southampton (UK): NIHR Journals Library; 2012 Mar.

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