Since we don’t have a retrospectoscope when we see our next patient, we need to have a good way of recognising possible sepsis and serious bacterial infection (SBI) amongst the large numbers of children with uncomplicated illnesses.
If fever and tachycardia are not specific, what can we rely on? Despite hopes to the contrary, routine near patient testing (e.g. CRP) in a primary care or emergency department setting will not give us the answer.
If neither numbers nor tests can sort the few out from the many, what is left? Simply put, a global assessment made by an experienced clinician is what really brings the magic to the decision making. So what is it that helps them to make a decision? The answer is complicated but essentially, they put together a jigsaw of features and come up with enough of a picture so that the puzzle makes sense. Some of the jigsaw pieces are fairly obvious but some of them are less well known or involve that tacit element of the process. It is worth being aware of the various factors that influence this crucial decision.