M Thompson

University of Washington Seattle, Seattle, Washington, United States

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Publications (20)109.16 Total impact

  • S. Neill · C. Jones · D. Roland · M. Thompson · M. Lakhanpaul ·
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    ABSTRACT: Safety netting has conventionally been used during consultations when clinicians are uncertain about the trajectory of an illness to provide patients with guidance about when and where to re-consult (Roland et al 2013). Recent high profile events involving failure to recognise and appropriately safety net children with sepsis highlights this is a significant issue in healthcare.
    Archives of Disease in Childhood 04/2015; 100(Suppl 3):A12-A12. DOI:10.1136/archdischild-2015-308599.28 · 2.90 Impact Factor
  • R. Stevens · S. Fleming · E. Spencer · M. Thompson · H. Ashdown ·
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    ABSTRACT: Background Driving accidents cause 1.2 million deaths each year worldwide, with alcohol a causative factor in at least one fifth. Breath alcohol is a well-established surrogate measure for blood alcohol and the portable breathalyser technology available to police forces has evidential force in some jurisdictions. However, in recent years cheap breathalysers have been marketed directly to the UK public, potentially allowing users to assess their own fitness to drive. We aimed to determine the accuracy of three selected breathalysers marketed to the UK public. Methods Diagnostic accuracy study of three personal breathalysers (two single-use and one digital multi-use) available to UK consumers, using as reference test an evidential standard breathalyser used by police. We recruited 208 participants aged 18 or over who had consumed alcohol in participating licensed bars in Oxford, United Kingdom. Participants answered a short questionnaire including self-reported recollection of alcohol consumption during the preceding 12 h, and used the breathalysers in a random order. We calculated sensitivity and specificity of each index device for detection of alcohol levels at or over the UK/US driving limit (35 µg/100ml breath alcohol concentration), using the police breathalyser as reference standard. We also calculated diagnostic accuracy of self-reported alcohol consumption. Results 38/208 (18.3%) of participants were at or over the driving limit according to the police breathalyser. The digital multi-use breathalyser had a sensitivity of 89.5% (95% CI 75.9–95.8%) and a specificity of 64.1% (95% CI 56.6–71.0%). The single-use breathalysers had a sensitivity of 94.7% (95% CI 75.4–99.1%) and 26.3% (95% CI 11.8–48.8%), and a specificity of 50.6% (95% CI 40.4–60.7%) and 97.5% (95% CI 91.4–99.3%) respectively. Self-reported alcohol consumption threshold of 5 UK units or fewer had a higher sensitivity than all personal breathalysers. Conclusion While two of the breathalysers tested had good sensitivity, one had very poor sensitivity. None were superior to estimation of self-reported alcohol consumption. Limitations of our study include the surrogate reference standard. The value, and safety, of marketing insensitive breathalysers to the public is open to question.
    Journal of Epidemiology &amp Community Health 09/2014; 68(Suppl 1):A7-A7. DOI:10.1136/jech-2014-204726.11 · 3.50 Impact Factor
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    I. Onakpoya · E. Spencer · C. Heneghan · M. Thompson ·
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    ABSTRACT: Introduction Many different dietary supplements are currently marketed for the management of hypertension, but the evidence for effectiveness is mixed. The aim of this systematic review was to evaluate the evidence for or against the effectiveness of green tea (Camellia sinensis) on blood pressure and lipid parameters. Methods Electronic searches were conducted in Medline, Embase, Amed, Cinahl and the Cochrane Library to identify relevant human randomized clinical trials (RCTs). Hand searches of bibliographies were also conducted. The reporting quality of included studies was assessed using a checklist adapted from the CONSORT Statement. Two reviewers independently determined eligibility, assessed the reporting quality of the included studies, and extracted the data. Results 474 citations were identified and 20 RCTs comprising 1,536 participants were included. There were variations in the designs of the RCTs. A meta-analysis revealed a significant reduction in systolic blood pressure favouring green tea (MD: -1.94 mmHg; 95% CI: -2.95 to -0.93; I2=8%; p = 0.0002). Similar results were also observed for total cholesterol (MD: -0.13 mmol/l; 95% CI: -0.2 to -0.07; I2=8%; p < 0.0001) and LDL cholesterol (MD: -0.19 mmol/l; 95% CI: -0.3 to -0.09; I2=70%; p = 0.0004). Adverse events included rash, elevated blood pressure, and abdominal discomfort. Conclusion Green tea intake results in significant reductions in systolic blood pressure, total cholesterol, and LDL cholesterol. The effect size on systolic blood pressure is small, but the effects on total and LDL cholesterol appear moderate. Longer-term independent clinical trials evaluating the effects of green tea are warranted.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 08/2014; 24(8). DOI:10.1016/j.numecd.2014.01.016 · 3.32 Impact Factor
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    C. Blacklock · A. M. Ward · C. Heneghan · M. Thompson ·
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    ABSTRACT: The migration of healthcare workers from Africa depletes countries already suffering from substantial staffing shortages and considerable disease burdens. The recruitment of such individuals by high income countries has been condemned by the World Health Organisation. However, understanding the reasons why healthcare workers migrate is essential, in order to attempt to alter migration decisions. We aimed to systematically analyse factors influencing healthcare workers' decisions to migrate from Africa. We systematically searched CINAHL (1980–Nov 2010), Embase (1980–Nov 2010), Global Health (1973–Nov 2010) and Medline (1950–Nov 2010) for qualitative studies of healthcare workers from Africa which specifically explored views about migration. Two reviewers identified articles, extracted data and assessed quality of included studies. Meta-ethnography was used to synthesise new lines of understanding and meaning from the data. The search identified 1203 articles from which we included six studies of healthcare workers trained in seven African countries, namely doctors or medical students (two studies), nurses (three), and pharmacy students (one study). Using meta-ethnographic synthesis we produced six lines of argument relating to the migration decisions of healthcare workers: 1) Struggle to realise unmet material expectations of self, family and society, 2) Strain and emotion, interpersonal discord, and insecurity in workplace, 3) Fear from threats to personal or family safety, in and out of workplace, 4) Absence of adequate professional support and development, 5) Desire for professional prestige and respect, 6) Conviction that hopes and goals for the future will be fulfilled overseas. We conclude that a complex interaction of factors contribute to the migration decisions of healthcare workers from Africa. Some of the factors identified are more amenable to change than others, and addressing these may significantly affect migration decisions of African healthcare workers in the future.
    Social Science [?] Medicine 01/2014; 100:99–106. DOI:10.1016/j.socscimed.2013.10.032 · 2.89 Impact Factor
  • I Onakpoya · C Heneghan · M Thompson ·

    09/2013; 18(3). DOI:10.1111/fct.12045
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    ABSTRACT: Prevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs derived from such countries. We searched the Cochrane database of systematic reviews for reviews relating to NCDs highlighted in the WHO NCD action plan (cardiovascular, cancers, diabetes and chronic respiratory diseases). We excluded reviews at the protocol stage and those that were repeated or had been withdrawn. For each review, two independent researchers extracted data relating to the country of the corresponding author and the number of trials and participants from countries, using the World Bank classification of gross national income per capita. 797 reviews were analysed, with a reported total number of 12 340 trials and 10 937 306 participants. Of the corresponding authors 90% were from high-income countries (41% from the UK). Of the 746 reviews in which at least one trial had met the inclusion criteria, only 55% provided a summary of the country of included trials. Analysis of the 633 reviews in which country of trials could be established revealed that almost 90% of trials and over 80% of participants were from high-income countries. 438 (5%) trials including 1 145 013 (11.7%) participants were undertaken in low-middle income countries. We found that only 13 (0.15%) trials with 982 (0.01%) participants were undertaken in low-income countries. Other than the five Cochrane NCD corresponding authors from South Africa, only one other corresponding author was from Africa (Gambia). The overwhelming body of evidence for NCDs pertains to high-income countries, with only a small number of review authors based in low-income settings. As a consequence, there is an urgent need for research infrastructure and funding for the undertaking of high-quality trials in this area.
    BMJ Open 07/2013; 3(7). DOI:10.1136/bmjopen-2013-003298 · 2.27 Impact Factor
  • C. Jones · S. Neill · M. Lakhanpaul · D. Roland · M. Thompson ·

    Archives of Disease in Childhood 06/2013; 98(Suppl 1):A58-A58. DOI:10.1136/archdischild-2013-304107.134 · 2.90 Impact Factor
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    M. Lakhanpaul · S. Neill · C. Shang · M. Thompson ·
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    ABSTRACT: Background and Aims Uncertainty and anxiety surround parents’ decisions to seek medical help for a sick child at home because parents are concerned not to miss serious illness whilst also not bothering the doctor unnecessarily. This dilemma leads to parents’ desire for more information to support their decision making. Factors influencing the success of information resources need to be identified prior to the development of safety netting interventions for families. The ASK SNIFF team (Acutely Sick Kid Safety Netting Interventions for Families) aimed to review the literature on the effectivenss of existing resources to provide an evidence base for the develoment of safety netting information for parents to be used when determining to seek help for an acutely sick child. Methods The initial stage of the project involved a systematic review using narrative analysis to identify influences on the effectiveness of information resources for parents caring for an acutely ill child at home. Results A range of measures for effectiveness have been used in the literature which limits their comparison. Interventions that included information on more than one illness or symptom were found to be more effective. Parents were more likely to act on information provided to them in the community than in the emergency department. Co- created information by parents and health professionals were found to be more successful. Conclusions Safety netting information resources may be more effective if they are designed with parents and their content, mode and place delivery is evidence based.
    Archives of Disease in Childhood 10/2012; 97(Suppl 2):A494-A495. DOI:10.1136/archdischild-2012-302724.1749 · 2.90 Impact Factor
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    R G Nijman · M Thompson · M van Veen · R Perera · H A Moll · R Oostenbrink ·
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    ABSTRACT: To develop reference values and centile charts for respiratory rate based on age and body temperature, and to determine how well these reference values can predict the presence of lower respiratory tract infections (LRTI) in children with fever. Prospective observational study. PARTICIPANTS : Febrile children aged at least 1 month to just under 16 years (derivation population, n = 1555; validation population, n = 671) selected from patients attending paediatric emergency departments or assessment units in hospitals. One hospital in the Netherlands in 2006 and 2008 (derivation population); one hospital in the Netherlands in 2003-05 and one hospital in the United Kingdom in 2005-06 (validation population). We used the derivation population to produce respiratory rate centile charts, and calculated 50th, 75th, 90th, and 97th centiles of respiratory rate at a specific body temperature. Multivariable regression analysis explored associations between respiratory rate, age, and temperature; results were validated in the validation population by calculating diagnostic performance measures, z scores, and corresponding centiles of children with diagnoses of pneumonic LRTI (as confirmed by chest radiograph), non-pneumonic LRTI, and non-LRTI. Age, respiratory rate (breaths/min) and body temperature (°C), presence of LRTI. Respiratory rate increased overall by 2.2 breaths/min per 1°C rise (standard error 0.2) after accounting for age and temperature in the model. We observed no interactions between age, temperature, and respiratory rates. Age and temperature dependent cut-off values at the 97th centile were more useful for ruling in LRTI (specificity 0.94 (95% confidence interval 0.92 to 0.96), positive likelihood ratio 3.66 (2.34 to 5.73)) than existing respiratory rate thresholds such as Advanced Pediatrics Life Support values (0.53 (0.48 to 0.57), 1.59 (1.41 to 1.80)). However, centile cut-offs could not discriminate between pneumonic LRTI and non-pneumonic LRTI. Age specific and temperature dependent centile charts describe new reference values for respiratory rate in children with fever. Cut-off values at the 97th centile were more useful in detecting the presence of LRTI than existing respiratory rate thresholds.
    BMJ (online) 07/2012; 345(jul03 1):e4224. DOI:10.1136/bmj.e4224 · 17.45 Impact Factor
  • S. Fleming · M. Thompson · M. Lakhanpaul ·

    Archives of Disease in Childhood 05/2012; 97(Suppl 1):A146-A146. DOI:10.1136/archdischild-2012-301885.348 · 2.90 Impact Factor
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    ABSTRACT: Although the vast majority of children with acute infections are managed at home, this is one of the most common problems encountered in children attending emergency departments (EDs) and primary care. Distinguishing children with serious infection from those with minor or self-limiting infection is difficult. This can result in misdiagnosis of children with serious infections, which results in a poorer health outcome, or a tendency to refer or admit children as a precaution; thus, inappropriately utilising secondary-care resources. We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets. We searched MEDLINE, Medion, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Database of Abstracts of Reviews of Effects in October 2008, with an update in June 2009, using search terms that included terms related to five components: serious infections, children, clinical history and examination, laboratory tests and ambulatory care settings. We also searched references of included studies, clinical content experts, and relevant National Institute for Health and Clinical Excellence guidelines to identify relevant studies. There were no language restrictions. Studies were eligible for inclusion if they were based in ambulatory settings in economically developed countries. Literature searching, selection and data extraction were carried out by two reviewers. We assessed quality using the quality assessment of diagnostic accuracy studies (QUADAS) instrument, and used spectrum bias and validity of the reference standard as exclusion criteria. We calculated the positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of each feature along with the pre- and post-test probabilities of the outcome. Meta-analysis was performed using the bivariate method when appropriate. We externally validated clinical prediction rules identified from the systematic review using existing data from children attending ED or primary care. We identified 1939 articles, of which 35 were selected for inclusion in the review. There was only a single study from primary care; all others were performed in the ED. The quality of the included studies was modest. We also identified seven data sets (11,045 children) to use for external validation. The most useful clinical features for ruling in serious infection was parental or clinician overall concern that the illness was different from previous illnesses or that something was wrong. In low- or intermediate-prevalence settings, the presence of fever had some diagnostic value. Additional red flag features included cyanosis, poor peripheral circulation, rapid breathing, crackles on auscultation, diminished breath sounds, meningeal irritation, petechial rash, decreased consciousness and seizures. Procalcitonin (LR+ 1.75-2.96, LR- 0.08-0.35) and C-reactive protein (LR+ 2.53-3.79, LR- 0.25-0.61) were superior to white cell counts. The best performing clinical prediction rule was a five-stage decision tree rule, consisting of the physician's gut feeling, dyspnoea, temperature ≥ 40 °C, diarrhoea and age. It was able to decrease the likelihood of serious infections substantially, but on validation it provided good ruling out value only in low-to-intermediate-prevalence settings (LR- 0.11-0.28). We also identified and validated the Yale Observation Scale and prediction rules for pneumonia, meningitis and gastroenteritis. Only a single study was identified from primary-care settings, therefore results may lack generalisability. Several clinical features are useful to increase or decrease the probability that a child has a serious infection. None is sufficient on its own to substantially raise or lower the risk of serious infection. Some are highly specific ('red flags'), so when present should prompt a more thorough or repeated assessment. C-reactive protein and procalcitonin demonstrate similar diagnostic characteristics and are both superior to white cell counts. However, even in children with a serious infection, red flags will occur infrequently, and their absence does not lower the risk. The diagnostic gap is currently filled by using clinical 'gut feeling' and diagnostic safety-netting, which are still not well defined. Although two prediction rules for serious infection and one for meningitis provided some diagnostic value, we do not recommend widespread implementation at this time. Future research is needed to identify predictors of serious infection in children in primary-care settings, to validate prediction rules more widely, and determine the added value of blood tests in primary-care settings. The National Institute for Health Research Health Technology Assessment programme.
    Health technology assessment (Winchester, England) 03/2012; 16(15):1-100. DOI:10.3310/hta16150 · 5.03 Impact Factor
  • Carl Heneghan · David Langton · M Thompson ·

    BMJ (online) 02/2012; 344(feb28 1):e1349. DOI:10.1136/bmj.e1349 · 17.45 Impact Factor
  • S Neill · C Shang · M Thompson · M Lakhanpaul ·

    01/2012; University of Northampton in collaboration with the University of Leicester and the University of Oxford.
  • C Blacklock · R Mayon-White · N Coad · M Thompson ·
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    ABSTRACT: Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment. Prospective diagnostic cohort study. Paediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust. 535 children aged between 3 months and 12 years with suspected acute infection. Parents completed a symptom questionnaire on arrival. Children were triaged by a nurse, who measured routine vital signs. The final diagnosis at discharge was used as the outcome. Symptoms and triage findings were analysed to identify features diagnostic of serious respiratory infection. Agreement between parent and triage nurse assessment was measured and kappa values calculated. Parent-reported symptoms were poor indicators of serious respiratory infection (positive likelihood ratio (LR+) 0.56-1.93) and agreed poorly with nurse assessment (kappa 0.22-0.56). The best predictor was clinical assessment of respiratory distress (LR+ 5.04). Oxygen saturations <94% were highly specific (specificity 95.1%) but had poor sensitivity (35.6%). Tachypnoea (defined by current Advanced Paediatric Life Support standards) offered little discriminatory value. Parent-reported symptoms were unreliable discriminators of serious respiratory infection in children with suspected acute infection, and did not correlate well with nurse assessment. Using symptoms to identify higher risk children in this setting is unreliable. Nurse triage assessment of respiratory distress and some vital signs are important predictors.
    Archives of Disease in Childhood 05/2011; 96(8):708-14. DOI:10.1136/adc.2010.206243 · 2.90 Impact Factor
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    C Heneghan · M Thompson · M Billingsley · D Cohen ·
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    ABSTRACT: Article Summary Article focus To describe the number of medical-device recalls in the UK that occurred over a 5-year period from 2006 to 2010. To determine the clinical data required at the time of regulation and the data available at the time of device recall. To determine the potential risk to patients associated with recalled medical devices. Key messages There was a substantial increase in field safety notices over the 5-year period. A substantial number of devices may have caused serious adverse effects in patients and contributed to healthcare costs over this time, but a lack of available transparent clinical data currently prevents full analyses of the safety impact of recalled devices in the UK. Of the highest-risk devices recalled, more than half were related to the cardiovascular system or the musculoskeletal system. Strengths and limitations of this study Strengths Quantification of all reported device recalls in the UK over a 5-year period. A breakdown by Conformité Européenne marked classification of device. An assessment of the potential harms of device recalls based on freely available published data on the Medicines and Health Regulatory Authority website. Limitations We were limited by a lack of available clinical data on recalled devices and the absence of a central registry, particularly of the highest-risk devices, which limited our ability to fully quantify and assess the implications of recalls on patient safety. Our classification of devices and Food and Drug Administration recall status was based on two general practitioners clinical experience, which means they may differ from manufacturers' classification and other clinicians. Owing to a lack of clinical data made available to us, we were unable to determine the reason for the rise in field safety notices. Also, we do not know when the problem first arose, and what kind of premarket clinical testing had been undertaken for many recalled devices.
    BMJ Open 05/2011; 1(1):e000155. DOI:10.1136/bmjopen-2011-000155 · 2.27 Impact Factor
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    Y Wan · C Heneghan · R Stevens · R J McManus · A Ward · R Perera · M Thompson · L Tarassenko · D Mant ·
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    ABSTRACT: The aim of this study is to systematically examine the proportion of accurate readings attained by automatic digital blood pressure (BP) devices in published validation studies. We included studies of automatic digital BP devices using recognized protocols. We summarized the data as mean and s.d. of differences between measured and observed BP, and proportion of measurements within 5 mm Hg. We included 79 articles (10,783 participants) reporting 113 studies from 22 different countries. Overall, 25/31 (81%), 37/41 (90%) and 34/35 (97%) devices passed the relevant protocols [BHS, AAMI and ESH international protocol (ESH-IP), respectively]. For devices that passed the BHS protocol, the proportion of measured values within 5 mm Hg of the observed value ranged from 60 to 86% (AAMI protocol 47-94% and ESH-IP 54-89%). The results for the same device varied significantly when a different protocol was used (Omron HEM-907 80% of readings were within 5 mm Hg using the AAMI protocol compared with 62% with the ESH-IP). Even devices with a mean difference of zero show high variation: a device with 74% of BP measurements within 5 mm Hg would require six further BP measurements to reduce variation to 95% of readings within 5 mm Hg. Current protocols for validating BP monitors give no guarantee of accuracy in clinical practice. Devices may pass even the most rigorous protocol with as few as 60% of readings within 5 mm Hg of the observed value. Multiple readings are essential to provide clinicians and patients with accurate information on which to base diagnostic and treatment decisions.
    Journal of human hypertension 04/2010; 24(7):431-8. DOI:10.1038/jhh.2010.37 · 2.70 Impact Factor
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    C Heneghan · P Glasziou · M Thompson · P Rose · J Balla · D Lasserson · C Scott · R Perera ·
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    ABSTRACT: The strategies used by general practitioners in making a diagnosis are being formally recognised; this article is the first in a series that will illustrate their application, and is accompanied by a case study (doi:10.1136/bmj.b1187)
    BMJ (online) 02/2009; 338(apr20 1):b946. DOI:10.1136/bmj.b946 · 17.45 Impact Factor
  • S. Fleming · L. Tarassenko · M. Thompson · D. Mant ·
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    ABSTRACT: Children presenting to an emergency care provider, such as an out-of-hours GP or Emergency Department, frequently have minor, self-limiting infections. However, a few will have a serious infection or complication, requiring urgent investigation and treatment to reduce the risk of long-term disability or death. Vital signs can be measured quickly and non-invasively on these children. However, no single sign is sufficiently predictive to accurately identify the children at risk. This is because signs may be physiologically coupled (e.g. heart rate and temperature), and also because the normal range of some signs, such as the breathing rate and heart rate, change with the age of the child. We propose a data fusion technique to identify children with serious illness from a combination of non-invasive vital signs and the age of the child. The technique has been applied to a dataset collected in primary care situations, and has shown that sensitivities and specificities of over 70% can be achieved.
  • M Thompson · A Harnden · R Perera · R Mayon-White · L Smith · D McLeod · D Mant ·
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    ABSTRACT: To describe the reference range for heart rate in children aged 3 months-10 years presenting to primary care with self-limiting infections. Cross-sectional study of children presenting to primary care with suspected acute infection. Heart rate was measured using a pulse oximeter and axillary temperature using an electronic thermometer. Centile charts of heart rates expected at given temperatures for children with self-limiting infections were calculated. Ten general practice surgeries and two out-of-hours centres in England. 1933 children presenting with suspected acute infections were recruited from in-hours general practice surgeries (1050 or 54.3%) or out-of-hours centres (883 or 45.7%). After excluding children who subsequently attended hospital and those without a final diagnosis of acute infection, 1589 children were used to create the centile charts of whom (859 or 54.1%) had upper respiratory tract infections and (215 or 13.5%) non-specific viral illness. Median, 75th, 90th and 97th centiles of heart rate at each temperature level. Heart rate increased by 9.9-14.1 bpm with each 1 degrees C increment in temperature. The 50th, 75th, 90th and 97th centiles of heart rate at each temperature level are presented graphically. Age-specific centile charts of heart rates expected at different temperatures should be used by clinicians in the initial assessment of children with acute infections. The charts will identify children who have a heart rate higher than expected for a given temperature and facilitate the interpretation of changes in heart rate on reassessment. Further research on the predictive value of the centile charts is needed to optimise their diagnostic utility.
    Archives of Disease in Childhood 12/2008; 94(5):361-5. DOI:10.1136/adc.2008.145011 · 2.90 Impact Factor
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    Carl Heneghan · M Thompson · R Perera ·

    BMJ (online) 11/2006; 333(7572):764-5. DOI:10.1136/bmj.38996.709340.BE · 17.45 Impact Factor

Publication Stats

221 Citations
109.16 Total Impact Points


  • 2014
    • University of Washington Seattle
      • Department of Family Medicine
      Seattle, Washington, United States
  • 2008-2014
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, England, United Kingdom
  • 2012
    • The University of Northampton
      Northampton, England, United Kingdom