Recognising severe infection: in hoc signo vinces?

摘要

As a junior doctor some years back, more than I can believe now, I remember the anxiety and anticipation I felt as I contacted a family who had taken their toddler home from accident and emergency after reassurance. A blood culture had then rapidly grown a meningococcus. The child was fine after readmission and treatment. It is a singular concern for any doctor dealing with a child presenting acutely with possible infection that they might miss severe bacterial sepsis. Those of us who have worked in paediatric intensive care will all have felt a shudder hearing stories from parents of children with serious illness that was not recognised. We may have looked at our own sick children at 3:00 am and remembered a parent's chilling phrase or description. Last winter H1N1 flu again reminded us just how hard it can be to get a diagnosis right.