Paediatrics measurements not always necessary

Five common measurements or procedures within paediatrics are insufficiently accurate or useful for clinical practice so the popular motto ‘the knowledge is in the number’ [in Dutch: meten is weten] does not always apply. This has been revealed by research conducted by UMCG PhD student Jolita Bekhof, who works as a paediatrician in the Isala Clinics in Zwolle. Supplementary tests do not lead to less anxiety or symptoms in patients. In paediatrics in particular, it is thus important to critically examine supplementary measurements or tests because most children in the West are healthy. Bekhof will be awarded a PhD by the University of Groningen on 18 June.

Doctors are keen on measurements for several reasons: they can reduce the uncertainty factor in a diagnosis and they can reassure the patient – or even the doctor. In addition, doctors are trained in the principle of ‘to measure is to know’ and thus have an almost blind trust in figures. However, every measurement could harm the patient, especially if it is invasive. Further, every measurement costs money and false positive results are also possible. If there is not much chance of a particular disease being present, previous research has already revealed that supplementary tests do not make the patient less anxious or reduce the symptoms.

In her thesis, Bekhof tested the reliability and the usefulness of five common measurements or procedures used in paediatrics: measuring the glucose in the urine in the nappies of neonates with the help of test strips, the diagnostic value of clinical symptoms (including glycosuria) when looking for serious infections in premature babies, the fluid balance in ill neonates, the assessment of the degree of shortness of breath in children, and the use of viral tests with bronchiolitis.

Her research revealed that only the testing of glucose with test strips was reliable; the other measurements or procedures were insufficiently accurate or turned out to be insufficiently useful in clinical practice. Bekhof thus came to the conclusion that the motto ‘to measure is to know’ is definitely not always applicable. Bekhof: ‘This starting point only applies on condition that you know what you are measuring, how, why and who.’ Her research also revealed that it could be useful to re-examine many of the routine measurements. According to Bekhof, this certainly applies to paediatrics: ‘In paediatrics in particular, it is important to critically examine supplementary measurements or tests because most children in the West are healthy.’

In clinical practice in Zwolle, the principle is evidence-based practice. That principle creates a self-critical and enquiring attitude, laying the foundations for Bekhof’s thesis: ‘If we cannot find a satisfactory answer to a question in the available literature, we often draw up a research proposal. We then examine whether we can resolve this proposal with a study within our own practice. The topics examined in my thesis have all arisen from such discussions and the resulting studies.’

Curriculum vitae

Jolita Bekhof (Leeuwarden, 1971) studied medicine at the University of Groningen and trained as a paediatrician at the UMCG. She conducted her research at the Amalia Kindercentrum of the Isala Clinics in Zwolle. Her thesis is entitled ‘Demystification of commonly used measurements in paediatrics’. She will remain working as a paediatrician at the Isala Clinics after receiving her PhD.