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A simple Fibonacci weighted scoring system to rate examinations of children with respiratory illness


A thorough examination of the head and neck is necessary to establish a diagnosis in pyrexial children, and for the exclusion of rare, but not to be missed conditions, such as Lymphoma and EBV. Scoring systems are a key tool in providing feedback to clinicians on how well these are carried out, and tracking their improvements. This audit looked at how well children with suspected respiratory illness were examined and how this was improved with such a tool. Feverish children over the age of 6 months were tracked: by whom they saw and how well they were examined. The quality of examination was stratified under a 3-teir standard (Gold, Silver and Bronze) with the “Gold” examinations including correct documentation of the state of ears, throat and lymph nodes, with Silver and Bronze allocated to standards approaching this. This Fennobacci-weighted scoring system was employed to average a score achieved by each grade over 21-month periods. Clinicians had re-education on the clinical exams in the interim. Junior doctors improved scores by 25%, nurse practitioners by 112% and more senior grades by 6%. The scoring system proved a motivational feedback mechanism across teams. Revalidation and confidence-building are required for doctors in training to achieve a high consistency in clinical examination, and novel scoring systems can be helpful in achieving this. 


otolaryngology, paediatrics, clinical examination, fever, COVID 19