A5V4d

Conjunctivitis (identified in 2013 review)
Clinical assessment of the child with fever
Conjunctivitis was reported in one study. The sensitivity for detecting urinary tract infection was low.
The specificity was high. The positive predictive value was low and the negative predictive value was
high. The likelihood ratios were not strong.
Poor peripheral circulation (identified in 2013 review)
Poor peripheral circulation 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 serious bacterial infection.
Bulging abdomen (identified in 2013 review)
Bulging abdomen 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 serious
bacterial infection.
Paresis or paralysis (identified in 2013 review)
Paresis or paralysis was reported in one study. The sensitivity for detecting bacterial meningitis was
low. The specificity was high, the positive and negative predictive values were not high, and the
likelihood ratios were not strong.
Abnormal neurological findings (identified in 2013 review)
Abnormal neurological findings were reported in three studies, including neurological deficit. The
sensitivity for detecting bacterial meningitis ranged from high to low. The specificity ranged from high
to moderate. The positive predictive values were not high and the negative predictive values were
high. The positive likelihood ratio ranged from convincing to strong, and the negative likelihood ratio
from convincing to not strong.
Impression of tone (identified in 2013 review)
Impression of tone was reported in one study. The study reported no significant association between
the symptom/sign and bacteraemia.
Tenderness on examination (identified in 2013 review)
Tenderness on examination was reported in one study. The sensitivity for detecting urinary tract
infection was low. The specificity was high. The positive predictive value was low and the negative
predictive value was high. The likelihood ratios were not strong.
Urinary symptoms (identified in 2013 review)
Urinary symptoms were reported in two studies. The sensitivity for detecting serious bacterial infection
was low. The specificity was high. The positive predictive value was low and the negative predictive
value was high. The likelihood ratios were not strong.
Abnormal ear, nose and throat signs (identified in 2013 review)
Abnormal ear, nose and throat signs were reported in two studies, including ‘ear problems’ reported in
one study. The sensitivity and positive predictive values for detecting serious bacterial infection were
not high. The specificity was high in one study and low in the other study. The negative predictive
value was high in both studies. The likelihood ratios were not strong in either study.
Rigor and/or chills (identified in 2013 review)
Rigor and/or chills were reported in one study. The sensitivity, specificity, positive predictive value and
negative predictive value for detecting bacterial illness were not high. The likelihood ratios were not
strong.
Cold hands and feet (identified in 2013 review)
No studies were found that looked specifically at cold hands and feet for detecting serious illness in
febrile children.
Yale Observation Scale
The Yale Observation Scale was reported in 12 studies. The sensitivity, specificity and positive
predictive value ranged from high to low for detecting serious illness, bacteraemia, pneumonia,
serious bacterial infection, bacterial disease and/or urinary tract infection, but were not correlated with
97
2013 Update