Doctors who experience a gut feeling when treating a child should not ignore it, according to a new study.
The study, from researchers at the University of Oxford, found that serious infections can be easily missed in young children, noting that making a diagnosis is often like finding a needle in a haystack.
The researchers claim that a doctor’s intuitive feeling that something is wrong, even after an examination suggests otherwise, appears to have even greater diagnostic value than most symptoms and signs.
Researchers from Oxford and Belgium carried out an observational study on 3,890 children up to the age of 16 who visited primary care physicians in Flanders, Belgium, in 2004.
To determine what added value gut feeling provides to a diagnosis, they looked at a variety of factors, including the doctor’s overall impression and whether gut feeling suggested something more serious was wrong. Gut feeling was defined as “intuitive feeling that something was wrong even if the clinician was unsure why.”
Of the 3,369 children assessed as having a non-severe illness at the time of consultation, six (0.2 percent) were later admitted to a hospital with a serious infection. Results show that acting on gut feeling had the potential to prevent two of the six cases being missed at the cost of 44 false alarms, but that these were not “unmanageable.”
The probability of a serious infection decreased from 0.2 percent to 0.1 percent when gut feeling was absent.
In fact, 21 out of the 3,890 children were eventually admitted to hospital with a serious infection and nine were not referred at first contact, the researchers report in the study, which was published in the British Medical Journal.
However, in four of the nine children, the doctor had a gut feeling that something serious was wrong.
The feature most strongly associated with gut feeling was a history of convulsions and the child’s overall appearance and breathing. The researchers also found that gut feeling is strongly influenced by parental concern that the illness is different.
Finally, less experienced clinicians reported it more frequently than their more senior counterparts. However, the diagnostic power of gut feeling was no better in experienced than non-experienced clinicians.
The researchers recommend that medical schools should make it clear that an “inexplicable gut feeling is an important diagnostic sign and a very good reason for seeking the opinion of someone with more pediatric expertise or performing additional testing.”
They add that having a gut feeling should make three things mandatory: Conducting a full and careful examination; seeking advice from a more experienced clinician; and providing the parent with “safety net” advice.
Source: British Medical Journal