A5V4d

Feverish illness in children
Neck stiffness (in 2007 traffic light table)
Nuchal rigidity was reported in three studies. The sensitivity was low for detecting bacterial meningitis
or meningococcal disease. The specificity was high. The positive and negatives predictive values
ranged from high to moderate. The positive likelihood ratio was either not calculable or convincing.
The negative likelihood ratios were not strong.
Status epilepticus (in 2007 traffic light table)
No evidence was reported on the use of status epilepticus to detect serious illness.
Focal neurological signs (in 2007 traffic light table)
No evidence was reported on the use of focal neurological signs to detect serious illness.
Focal seizures (in 2007 traffic light table)
Focal seizures were reported in two studies. The sensitivity was low for detecting bacterial meningitis.
The specificity was high. The positive predictive values were low and the negative predictive values
were high. The positive likelihood ratios ranged from not strong to strong and the negative likelihood
ratios were not strong.
A new lump larger than 2 cm (in 2007 traffic light table)
No evidence was reported on the use of a new lump larger than 2 cm to detect serious illness.
Bile-stained vomiting (in 2007 traffic light table)
No evidence was reported on the use of bile-stained vomiting to detect serious illness.
Diarrhoea (identified in 2013 review)
Diarrhoea was reported in five studies including diarrhoea alone, diarrhoea with vomiting, and ‘mild
gastrointestinal symptoms’. The sensitivity, specificity and positive predictive value for using diarrhoea
to detect serious bacterial infection was low. The negative predictive value ranged from high to low.
The likelihood ratios were not strong. The specificity for using diarrhoea and vomiting or mild
gastrointestinal symptoms to detect serious bacterial infection was moderate to high, although the
sensitivity, positive predictive value and negative predictive value were not high and the likelihood
ratios were not strong. One study reported that the odds of having a bacterial illness are 3.9 times
greater in those with diarrhoea compared to those without diarrhoea. One study reported that
diarrhoea was not predictive of urinary tract infection.
Vomiting (identified in 2013 review)
Vomiting was reported in 11 studies, including increased vomiting, vomiting reported with diarrhoea,
and ‘mild gastrointestinal symptoms’. The sensitivity for detecting serious bacterial infection, serious
disease, bacterial illness, urinary tract infection, bacterial meningitis or meningococcal disease was
low. The specificity, positive predictive value and negative predictive value ranged from high to low.
The likelihood ratios were not strong. One study reported that the odds of having a bacterial illness
were not significantly different in those with vomiting compared with those without. One of the studies
reported that vomiting was not predictive of urinary tract infection.
Abdominal pain (identified in 2013 review)
Abdominal pain was reported in two studies. One study reported a low sensitivity and positive
predictive value and high specificity and negative predictive value for detecting serious illness. The
likelihood ratios were not strong. The other study reported no significant association between
abdominal pain and urinary tract infection.
Crying on micturition/dysuria (identified in 2013 review)
Crying on micturition/dysuria was reported in one study. The sensitivity, specificity, positive predictive
value and negative predictive value were not high, and the likelihood ratios were not strong, for
detecting urinary tract infection.
Headache (identified in 2013 review)
Headache was reported in one study. The sensitivity for detecting bacterial meningitis was low. The
specificity was high. The positive predictive value was low and the negative predictive value was high.
The positive likelihood ratio was convincing, although the negative likelihood ratio was not strong.
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2013 Update