A5V4d

Table 5.57 GRADE findings for evaluation of elevated heart rate
Number
of
studies
Number
of
children
Elevated heart rate a
Sensitivity
(95%
confidence
interval)
Specificity
(95%
confidence
interval)
Positive
predictive
value
(95%
confidence
interval)
For detecting pneumonia, urinary tract infection, or bacteraemia
1 (Craig,
2010)
1
(Thomps
on,
2009)
12,807 58 (55 to
61)
691 62 (57 to
68)
58 (57 to
59)
58 (53 to
63)
Clinical assessment of the child with fever
Negative
predictive
value
(95%
confidence
interval)
10 (9 to 10) 95 (94 to
95)
Positive
likelihood
ratio
(95%
confidence
interval)
1.4 (1.3 to
1.5)
NR NR 1.5 (1.3 to
1.7)
Negative
likelihood
ratio
(95%
confidence
interval)
0.7 (0.7 to
0.8)
0.7 (0.6 to
0.8)
Quality
NR Not reported
a Based on figures: Age (years) and recommended upper limit of normal for FEVER study (source): 0 = 160 (WHO); 1 = 150
(WHO); 2 = 150 (WHO); 3 = 140 (WHO); 4 = 130 (Wallis); 5 = 120 (Wallis). From: 1) Wallis et al, Arch. Dis. Child.
2005;90;1117-1121. 2) WHO. Pocket Book of Hospital Care for Children: Guidelines for the management of common illnesses
with limited resources. 2005, page 232.
Heart rate alone and in conjunction with temperature in the clinical assessment of
serious illness
Only one study was identified that addressed the review question. This was a cross-sectional
prospective study (Brent et al., 2011) that included two datasets which were analysed and reported
separately. The first included 1360 children presenting at a paediatric emergency department with
suspected serious bacterial infection; the second included 325 children presenting to hospital with
meningitis. The study examined whether serious bacterial infection could be identified by heart rate in
conjunction with temperature or heart rate alone.
Dataset including 1360 children presenting at a paediatric emergency department with
suspected serious bacterial infection
In the first part of the Brent study, age-specific centile charts of heart rate plotted against temperature
were produced (see Figure 5.1). The distribution of children with or without serious bacterial infection
and the odds ratios (OR) for serious bacterial infection were examined (see Table 5.59) and there
was no significant trend across the temperature heart rate charts in the proportion of children with
serious bacterial infection (P = 0.288). Table 5.60 shows that diagnostic usefulness was high
specificity above 90 th centile, but low for sensitivity, PPV and NPV, and the test was not useful in
terms of LR+ or LR-.
Dataset including 325 children presenting to hospital with meningitis
In the second part of the Brent study, age-specific centile charts were plotted of heart rate against
temperature involving children presenting at hospital with meningitis (see Figure 5.2). The sensitivity
cut-offs defined by temperature heart rate centile, heart rate and tachycardia are shown in Table 5.58
(see also Table 5.61). Higher temperature and heart rate centile categories and higher heart rate
centile categories showed a higher proportion of children with severe disease (P = 0.041 and P =
0.004, respectively).
A limitation in the first part of the study was the lack of a clear gold standard for the definition of
severe bacterial illness. The main limitation in the second part of the study was that the study included
only children with meningococcal disease.
Low
Low
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2013 Update