Parental Ability to Identify Severe Illnesses in Their Children

Importance: Early parental recognition of severe illness in children and adolescents is crucial for timely management and improved outcomes in pediatric emergency care. Objective: To assess how accurately parents can identify severe illness in their children using a questionnaire completed shortly after arrival at the emergency department (ED). Design, Setting, and Participants: This diagnostic study was conducted in a tertiary pediatric ED in northern Finland. Data were collected in 2019 to 2021, and this analysis was conducted in May 2024 to May 2025. Children and adolescents whose parents completed the questionnaire before physician assessment were included. Exposures: A structured, 36-item parental questionnaire assessing symptoms and the child or adolescent's overall condition. Main Outcomes and Measures: Severe illness was defined as 1 or more of the following: admission to the pediatric intensive care unit, hospital treatment of more than 24 hours, need for intravenous or nasogastric fluids, need for intravenous antibiotics for more than 24 hours, oxygen saturation less than 93% or the need for inhaled medications, anaphylactic shock, intoxication requiring hospital admission, or surgical intervention. Sensitivity and specificity were calculated for each question. To identify parental triage questions with the strongest diagnostic value, a machine learning analysis was conducted. Results: Among 2375 included children and adolescents (mean [SD] age, 5.4 [4.6] years; 1140 female [48.0%]), 567 individuals (23.9%) met criteria for severe illness. Moderate to high parental worry showed the highest sensitivity (91.0% [95% CI, 88.3%-93.2%]) but the lowest specificity (17.5% [95% CI, 15.8%-19.4%]). Other specific pediatric questions demonstrated modest diagnostic accuracy with limited additional value. The machine learning model (area under the receiver operating characteristic curve, 0.71; 95% CI, 0.65-0.77) identified parental worry (feature importance score, 0.047), parent assessments of child or adolescent's general condition (feature importance score, 0.046), and need for treatment (feature importance score, 0.141) as the strongest predictors of hospital admission. Conclusions and Relevance: In this study, parental worry identified most cases of severe illness but had low specificity. These findings suggest that while parental concern may serve as an initial screening indicator, it should be complemented by clinical evaluation and objective measures to avoid unnecessary escalation of care.