This report is a nice example of the power of System 1, the potential
interplay of System 1 and System 2, and the potential to refine the
colloquialisms (such as "gut", "intuition", and "gist") that we use to
refer to System 1.
Bruel, A. V. d., M. Thompson, et al. (2012). "Clinicians’ gut feeling
about serious infections in children: observational study." BMJ 345.
Objective To investigate the basis and added value of clinicians’ “gut
feeling” that infections in children are more serious than suggested by
clinical assessment.
Design Observational study.
Setting Primary care setting, Flanders, Belgium.
Participants Consecutive series of 3890 children and young people aged
0-16 years presenting in primary care.
Main outcome measures Presenting features, clinical assessment, doctors’
intuitive response at first contact with children in primary care, and
any subsequent diagnosis of serious infection determined from hospital
records.
Results Of the 3369 children and young people assessed clinically as
having a non-severe illness, six (0.2%) were subsequently admitted to
hospital with a serious infection. Intuition that something was wrong
despite the clinical assessment of non-severe illness substantially
increased the risk of serious illness (likelihood ratio 25.5, 95%
confidence interval 7.9 to 82.0) and acting on this gut feeling had the
potential to prevent two of the six cases being missed (33%, 95%
confidence interval 4.0% to 100%) at a cost of 44 false alarms (1.3%,
95% confidence interval 0.95% to 1.75%). The clinical features most
strongly associated with gut feeling were the children’s overall
response (drowsiness, no laughing), abnormal breathing, weight loss, and
convulsions. The strongest contextual factor was the parents’ concern
that the illness was different from their previous experience (odds
ratio 36.3, 95% confidence interval 12.3 to 107).
Jim
James M. Walker, MD, FACP
Chief Medical Information Officer
Geisinger Health System
The best way to predict the future is to invent it.
- Alan Kay
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