RT Journal Article SR Electronic T1 Vital signs, clinical rules, and gut feeling: an observational study among patients with fever JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP BJGPO.2021.0125 DO 10.3399/BJGPO.2021.0125 A1 Gideon HP Latten A1 Lieke Claassen A1 Lucinda Coumans A1 Vera Goedemondt A1 Calvin Brouwer A1 Jean WM Muris A1 Jochen WL Cals A1 Patricia M Stassen YR 2021 UL http://bjgpopen.org/content/early/2021/11/19/BJGPO.2021.0125.abstract AB Background GPs decide which patients with fever need referral to the emergency department (ED). Vital signs, clinical rules, and gut feeling can influence this critical management decision.Aim To investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling.Design & setting Prospective observational study at two out-of-hours (OOH) GP cooperatives in the Netherlands.Method During two 9-day periods, GPs performed their regular work-up in patients aged ≥18 years with fever (≥38.0°C). Subsequently, researchers measured missing vital signs for completion of the systemic inflammatory response syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score. Associations between the number of referrals, positive SIRS and qSOFA scores, and GPs’ gut feelings were investigated.Results GPs measured and recorded all vital signs required for SIRS criteria and qSOFA score calculations in 24 of 108 (22.2%) assessed patients, and referred 45 (41.7%) to the ED. Higher respiratory rates, temperatures, clinical rules, and gut feeling were associated with referral. During 7-day follow-up, nine (14.3%) of 63 patients who were initially not referred were admitted to hospital.Conclusion GPs measured and recorded all vital signs for SIRS criteria and qSOFA score in one-in-five patients with fever, and referred half of 63 patients who were SIRS-positive and almost all of 22 patients who were qSOFA-positive. Some vital signs and gut feeling were associated with referral, but none were consistently present in all patients who were referred. The vast majority of patients who were not initially referred remained at home during follow-up.