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Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain

Bibliographic Details
Journal Title: Clinical Pediatrics
Authors and Corporations: Huttenlocher, Anna, Newman, Thomas B.
In: Clinical Pediatrics, 36, 1997, 6, p. 339-344
Type of Resource: E-Article
Language: English
published:
SAGE Publications
Subjects:
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rft.atitle Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
rft.epage 344
rft.genre article
rft.issn 0009-9228
1938-2707
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rft.jtitle Clinical Pediatrics
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rft.pages 339-344
rft.pub SAGE Publications
rft.date 1997-06-01
x.date 1997-06-01T00:00:00Z
rft.spage 339
rft.volume 36
abstract <jats:p> An erythrocyte sedimentation rate (ESR) is commonly ordered as part of the evaluation of patients with nonspecific but potentially serious symptoms. To investigate the performance of ESR in this setting, we used a computerized database and medical chart review to identify children (n=299) with ESR done for a previously undiagnosed condition. Medical records were reviewed to determine symptoms at presentation, referral status, and subsequent diagnoses, which were classified as serious (n=93) or benign (n=206). We found that serious underlying disease was about 7 times as likely in patients with ESR&gt;50 mm/hr (57/102) than in patients with ESR&lt;20 mm/hr (7/89). Although the prevalence of serious disease was higher among referral patients, the likelihood ratios were similar for referral and primary-care patients. An erythrocyte sedimentation rate greater than 50 mm/hr was most informative in patients presenting with limp (likelihood ratio [LR] =8.2) and abdominal pain (LR=6.0) and least informative in patients presenting with fever (LR=2.5). On the other hand, an ESR&lt;20 mm/hr is reassuring in patients presenting with fever (LR=0) or limp (LR=0.3), but not in patients presenting with abdominal pain (LR=0.8). An ESR between 20 and 50 mm/hr (23% of the patients) provided little information (LR 1.2-1.5) in each of the three groups. These results suggest that the ESR often provides useful information about the likelihood of serious illness among children presenting with worrisome but nonspecific symptoms, in particular in patients presenting with limp. </jats:p>
authors Array ( [rft.aulast] => Huttenlocher [rft.aufirst] => Anna )
Array ( [rft.aulast] => Newman [rft.aufirst] => Thomas B. )
doi 10.1177/000992289703600605
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author Huttenlocher, Anna, Newman, Thomas B.
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description <jats:p> An erythrocyte sedimentation rate (ESR) is commonly ordered as part of the evaluation of patients with nonspecific but potentially serious symptoms. To investigate the performance of ESR in this setting, we used a computerized database and medical chart review to identify children (n=299) with ESR done for a previously undiagnosed condition. Medical records were reviewed to determine symptoms at presentation, referral status, and subsequent diagnoses, which were classified as serious (n=93) or benign (n=206). We found that serious underlying disease was about 7 times as likely in patients with ESR&gt;50 mm/hr (57/102) than in patients with ESR&lt;20 mm/hr (7/89). Although the prevalence of serious disease was higher among referral patients, the likelihood ratios were similar for referral and primary-care patients. An erythrocyte sedimentation rate greater than 50 mm/hr was most informative in patients presenting with limp (likelihood ratio [LR] =8.2) and abdominal pain (LR=6.0) and least informative in patients presenting with fever (LR=2.5). On the other hand, an ESR&lt;20 mm/hr is reassuring in patients presenting with fever (LR=0) or limp (LR=0.3), but not in patients presenting with abdominal pain (LR=0.8). An ESR between 20 and 50 mm/hr (23% of the patients) provided little information (LR 1.2-1.5) in each of the three groups. These results suggest that the ESR often provides useful information about the likelihood of serious illness among children presenting with worrisome but nonspecific symptoms, in particular in patients presenting with limp. </jats:p>
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spelling Huttenlocher, Anna Newman, Thomas B. 0009-9228 1938-2707 SAGE Publications Pediatrics, Perinatology and Child Health http://dx.doi.org/10.1177/000992289703600605 <jats:p> An erythrocyte sedimentation rate (ESR) is commonly ordered as part of the evaluation of patients with nonspecific but potentially serious symptoms. To investigate the performance of ESR in this setting, we used a computerized database and medical chart review to identify children (n=299) with ESR done for a previously undiagnosed condition. Medical records were reviewed to determine symptoms at presentation, referral status, and subsequent diagnoses, which were classified as serious (n=93) or benign (n=206). We found that serious underlying disease was about 7 times as likely in patients with ESR&gt;50 mm/hr (57/102) than in patients with ESR&lt;20 mm/hr (7/89). Although the prevalence of serious disease was higher among referral patients, the likelihood ratios were similar for referral and primary-care patients. An erythrocyte sedimentation rate greater than 50 mm/hr was most informative in patients presenting with limp (likelihood ratio [LR] =8.2) and abdominal pain (LR=6.0) and least informative in patients presenting with fever (LR=2.5). On the other hand, an ESR&lt;20 mm/hr is reassuring in patients presenting with fever (LR=0) or limp (LR=0.3), but not in patients presenting with abdominal pain (LR=0.8). An ESR between 20 and 50 mm/hr (23% of the patients) provided little information (LR 1.2-1.5) in each of the three groups. These results suggest that the ESR often provides useful information about the likelihood of serious illness among children presenting with worrisome but nonspecific symptoms, in particular in patients presenting with limp. </jats:p> Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain Clinical Pediatrics
spellingShingle Huttenlocher, Anna, Newman, Thomas B., Clinical Pediatrics, Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain, Pediatrics, Perinatology and Child Health
title Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
title_full Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
title_fullStr Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
title_full_unstemmed Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
title_short Evaluation of the Erythrocyte Sedimentation Rate in Children Presenting with Limp, Fever, or Abdominal Pain
title_sort evaluation of the erythrocyte sedimentation rate in children presenting with limp, fever, or abdominal pain
topic Pediatrics, Perinatology and Child Health
url http://dx.doi.org/10.1177/000992289703600605