Your "Gut"- You know When to Hold 'Em, and When to Fold 'Em

http://www.bmj.com/content/345/bmj.e6144

Above is a free article that summarizes what many practicing clinicians have long (literally) felt: sometimes you just have to "go" with your intuition. The article essentially validates that these "gut" impressions, especially for pediatrics, are accurate.
A few quick points:
- Yes, the article is from Europe where the malpractice climate may be different, but it still has a solid number of patients.
- Newer/less experienced providers still "have" a gut feeling, it is just that the "newbies" often lack the ability to clinically correlate it into a diagnosis. This finding is important. Heed your "gut" regardless of your experience level, and take correct action/referral.
-While I am staunchly against "fever phobia" the article revalidates the finding that for every degree over 102 F, your chance of an occult "deep" infection (pneumonia, uti/pyelonephritis, sepsis) increases. Specifically, the article states that 1 out of every 20 children with a documented fever over 40C/104F end up with a documented "significant" bacterial issue.
-Once again, the article is a firm reminder of the importance in children to document their immunization status. The decrease-thanks to immunization- in invasive forms of Streptococcus pneumoniae has been impressive over the years. As such, as previous blog articles have outlined, the days of "rocephinizing febrile kids for 2-3 days until the labs are normal" are fading. Converesely, unvaccinated kids, from an urgent care perspective, with high fever may be more needing of ER evaluation.
-Lastly, note that the "gut" impression is majorly composed of a global, "stepping back" and looking at the patient and observing! Sometimes it is best to just unclothe the child, step back 3 or 4 feet, and watch for the "eternity" of 30 seconds to a minute. This tactic displays thoroughness to parents and often yields important clincal information.
GO WITH YOUR GUT- IT USUALLY IS RIGHT!