Demystification of commonly used measurements in paediatrics

Measurements are essential In medical practice. Throughout their training, doctors are taught the adage “meten is weten” (the knowledge is in the numbers). In this thesis we evaluated various diagnostic measurements in paediatrics – across a wide age range, from neonates to older children – aimed at clarifying (demystifying) these commonly used procedures. We discuss the general aspects of uncertainty in medicine, since uncertainty is a major reason for performing diagnostic tests in the first place. Furthermore we explain the way evidence-based medicine (EBM) may help doctors to deal with this feeling of uncertainty.

The measurements investigated in this thesis are: 1) test strips for measurement of glucosuria in neonates, 2) diagnostic value of various clinical signs, including glucosuria, in identifying late-onset sepsis in premature neonates, 3) fluid-balance charts in neonates, 4) clinical assessment of severity of dyspnoea in children and 5) viral tests to identify and isolate RSV-infected infants hospitalised for bronchiolitis, for the purpose of reducing nosocomial cross-infection.
Apart from the test strips for measurement of glucosuria, all measurements or procedures we have investigated appeared to be too imprecise or of insufficiently useful in clinical practice.
In general we conclude that the adage “meten is weten” (the knowledge is in the numbers) still holds true, provided that one knows what is being measured, how the measurement is performed, by whom, and for what reason. Furthermore we would like to emphasize the importance of investigating common or routine procedures, and the role EBM has played when investigating this theme.