In infants less than 6 months old attending ED, can babycheck scoring system be used to predict decision of hospital admission by a senior clinician

Report By: Dr M.Hemavathi - ST3 Emergency Medicine
Search checked by Dr M.Hemavathi - ST3 Emergency Medicine
Institution: Hull Royal Infirmary
Date Submitted: 28th May 2008
Last Modified: 6th July 2008
Status: Blue (submitted but not checked)

Three Part Question

[In infants less than 6 months old attending ED][can babycheck scoring system be used to predict][decision of hospital admission by a senior clinician]

Clinical Scenario

A 5 month old infant attends A&E generally unwell. As an F2 you wonder if there is any scoring system which will help your

Search Strategy

( Baby Check OR Baby Check Score) and (serious illness OR severe illness) and (infants less than 6 months of age) LIMIT to human
MEDLINE - 1950 to date (MEZZ) using Dialog database

Search Outcome

12 relevant papers found but only 9 answered the clinical question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
CJ Morley et al, 1990 UK	298 babies at home (1-25 weeks of age) & 709 babies presenting to hospital with acute illness.	diagnostic	Sensitivity	93%	Inter-observer bias
CJ Morley et al, 1990 UK		diagnostic	Specificity	92%	Inter-observer bias
AJ Thorton et al 1990 UK	262 babies < 6 months attending hospital	diagnostic	Sensitivity	75%	Small numbers
			Specificity (score >13)	87%
			Specificity (score>20)	100%
			Good correlation between scores for registrars and Consultant Paediatricians
CJ Morley et al 1994 Gambia	53 babies <6 months of age attending OPD	diagnostic	Sensitivity	66%	Interpreter Background of Chronic illness
			Specificity	95%
			+predict value	75%
			- predict value	93%
Mark Twite et al 1995 India	100 babies 0-12 months presenting to OPD	diagnostic	Sensitivity	61%	Translation problems (drowsy, floppy) Axillary temp used. Unable to grade paleness Results extrapolated to 12 months
			Specificity	86%
			+predict value	80%
S Chandran et al 1998 Oman	90 infants from 1-6 months of age who presented to the clinic with acute illness	diagnostic	Sensitivity	77.4%	Background of Chronic illness
			Specificity	88.3%
			+predict value	87.5%
			-predict value	76%
CK Chen et al 1995 China	394 out of 495 babies <6 months of age attending ED between Apr 1992-Jul1992	diagnostic	False negative rate	14.2%	No explicit exclusion criterion Background of Chronic illness
CK Chen et al 1995 China		diagnostic	False positive rate	10.7%
CK Chen et al 1997 China	134 out of 495 babies <6 months of age attending ED between Apr 1992-Jul1992	diagnostic	Good correlation between scores for on duty interns, residents and senior Paediatricians	82-87%	No explicit exclusion criterion

Comment(s)

While there are many juniors doctors working in ED it is fairly challenging to identify seriously ill infants <6 months, a scoring system to identify them would be of great help. The studies show that the scoring system is fairly sensitive if the score >20. It does not apply for chronic illness, convulsions, injuries, and abscess. Caution in diseases with minimal clinical signs like UTI, hyperbilirubinemia

Editor Comment

Initially designed for gps Now being used by parents as well No RCT done

Clinical Bottom Line

Baby Check score card cannot replace clinical judgement. It can be used as an adjunct with the clinical exam findings to make a decision

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

Morley-C-J, Thornton-A-J, Cole-T-J, Hewson-P-H, Fowler-M-A. Baby Check:a scoring system to grade the severity of acute systemic illness in babies under 6 months old Archives of Disease in Childhood Jan 1991, vol. 66, no. 1, p. 100-5, ISSN: 1468-2044.
Thornton-A-J, Morley-C-J, Cole-T-J, Green-S-J, Walker-K-A, Rennie-J-M. Field trials of the Baby Check score card in hospital. Archives of disease in childhood, Jan 1991, vol. 66, no. 1, p. 115-20, ISSN: 1468-2044.
Morley-C-J, Rashiq-H, Thomas-I-R, Weaver-L-T. Use of Baby Check to assess the severity of illness in babies attending a clinic in The Gambia. Journal of tropical pediatrics Jun 1994, vol. 40, no. 3, p. 144-8, ISSN: 0142-6338.
Twite-M, Morley-C. Baby check in India: assessing the severity of illness in babies in a Calcutta out-patient clinic. Journal of tropical pediatrics Jun 1995, vol. 41, no. 3, p. 158-63, ISSN: 0142-6338.
Chandran-S, Sunita-K, Nair-A-K, Elbualy-M-S. A trial of baby check scoring system to identify high-risk infants in a polyclinic in Oman. Journal of tropical pediatrics Aug 1998, vol. 44, no. 4, p. 218-21, ISSN: 0142-6338.
Chen-C-K, Chen-S-J, Hwang-B. Evaluation of the baby check score in emergency room. Zhonghua Minguo xiao er ke yi xue hui za zhi (Journal). May-Jun 1995, vol. 36, no. 3, p. 187-91, ISSN: 0001-6578.
Chen-C-K, Chen-S-J, Hwang-B. Evaluation of the severity of illness in infants by the Baby Check Score. Zhonghua yi xue za zhi = Chinese medical journal Jan 1997, vol. 59, no. 1, p. 15-20, ISSN: 0578-1337.