A5V4d

Feverish illness in children
Nasal symptoms (identified in 2013 review)
Nasal symptoms were reported in three studies, with definitions including purulent nasal discharge,
upper respiratory tract infection or runny nose, and symptoms of mild upper respiratory tract infection.
The sensitivity was not high for detecting serious bacterial illness or urinary tract infection. The
specificity ranged from high to low. The positive predictive value was not high and the negative
predictive value ranged from high to low. The likelihood ratios were not strong.
Wheeze (identified in 2013 review)
Wheeze was reported in one study, including audible wheeze and stridor. The sensitivity was low for
detecting pneumonia, urinary tract infection or bacteraemia. The specificity was high. The positive
predictive values were low and the negative predictive values were high. The likelihood ratios were
not strong.
Chest findings/abnormal chest sounds (identified in 2013 review)
Chest findings/abnormal chest sounds were reported in two studies. The sensitivity was low for
detecting pneumonia, urinary tract infection or bacteraemia. The specificity was high. The positive
predictive values were low and the negative predictive values were high. The likelihood ratios were
not strong.
Cough (identified in 2013 review)
Cough was reported in three studies. The sensitivity was low for detecting pneumonia, urinary tract
infection, bacteraemia or meningococcal disease. The specificity ranged from high to low. The
positive predictive values were low and the negative predictive values ranged from high to moderate.
The likelihood ratios were not strong.
Hydration
Dry mucous membranes (in 2007 traffic light table)
No evidence was reported on the use of dry mucous membranes for detecting serious illness.
Reduced skin turgor (in 2007 traffic light table)
No evidence was reported on the use of reduced skin turgor for detecting serious illness.
Poor feeding (in 2007 traffic light table)
Poor feeding was reported in four studies; definitions used included poor intake and decreased
feeding. The sensitivity, specificity and positive predictive values ranged from moderate to low for
detecting serious bacterial infection, serious illness or urinary tract infection. The negative predictive
values ranged from high to low. The positive and negative likelihood ratios were not strong.
Capillary refill time of 3 seconds or more (in 2007 traffic light table)
Capillary refill time was reported in one study, using a time of 2 to 3 seconds or more than 3 seconds.
The sensitivity was low for detecting pneumonia, urinary tract infection or bacteraemia. The specificity
was high. The positive predictive value was low. The negative predictive value was high. The positive
likelihood ratio ranged from not strong to strong. The negative likelihood ratios were not strong.
Reduced urine output (in 2007 traffic light table)
Reduced urine output was reported by two studies, including poor micturition. The sensitivity was low
and the specificity was moderate for detecting urinary tract infection or serious bacterial infection. The
positive predictive value ranged from moderate to low and the negative predictive value ranged from
high to low. The likelihood ratios were not strong.
Other
Fever for 5 days or more (in 2007 traffic light table)
As shown in Table 5.22, duration of fever was reported in 17 studies, at the following time points: 12
hours, 24 hours, 48 hours, 2 days and 72 hours for detecting serious bacterial infection, bacteraemia,
meningococcal disease and urinary tract infection. All of the time points resulted in a low sensitivity.
The specificities ranged from high to low; however, the expected correlation between increasing
specificities and increasing fever duration was not found. Positive predictive values were mainly low.
Negative predictive values ranged from high to low, although again this was not in the expected
pattern. The positive and negative likelihood ratios were not strong for any cutoffs. There was no
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2013 Update