A5V4d

Feverish illness in children
Based on the available evidence and its discussion, the GDG decided that no changes relating to
oxygen saturation were needed to the traffic light table.
Moderate or severe chest indrawing (included in 2007 traffic light table)
Chest indrawing was included in the original traffic light table as a specific sign of pneumonia.
The current review did not find any further evidence regarding chest indrawing for detecting serious
illness.
The GDG decided it should be retained in the traffic light table. A definition of chest indrawing is
provided in the glossary.
Crackles (included in 2007 traffic light table)
The evidence relating to crackles in the 2013 review was of low and very low quality. The evidence
showed that children with crackles were not more likely to have a serious illness than children who did
not have crackles (not a strong positive likelihood ratio). In addition, the evidence suggested children
without a serious illness, such as pneumonia, a urinary tract infection or bacteraemia, usually did not
have crackles (high specificity). However, children with a serious illness, such as pneumonia, a
urinary tract infection or bacteraemia, also did not usually have crackles (low sensitivity). The
evidence was of low to very low quality.
Given the quality of the evidence, the GDG did not believe the evidence was strong enough to change
or remove an existing recommendation. Therefore, no changes relating to crackles were made to the
traffic light table.
Respiratory symptoms (identified in 2013 review)
The 2013 review highlighted that the evidence supports existing symptoms and signs in the original
traffic light table.
The GDG believed that the new evidence was not defined well enough to add anything further to the
assessment of respiratory symptoms.
Therefore, no changes relating to respiratory symptoms were made to the traffic light table.
Nasal symptoms (identified in 2013 review)
The evidence shows that serious illness is not ruled out by a lack of nasal symptoms (low sensitivity).
The GDG members were aware from their clinical experience that less serious complaints, such as
upper respiratory tract infections, are often used to rule out the presence of a serious illness.
However, the GDG stated that nasal symptoms were too common to be of practical use.
The GDG, therefore, did not add nasal symptoms to the ‘green’ column of the traffic light table.
Wheeze (or stridor) (identified in 2013 review)
The evidence shows that children who had wheeze were not more likely to have a serious illness than
children who did not have wheeze (not a strong positive likelihood ratio). In addition, the evidence
showed that children without a serious illness, such as pneumonia, a urinary tract infection or
bacteraemia, usually did not have wheeze (high specificity). However, children with a serious illness,
such as pneumonia, a urinary tract infection or bacteraemia, also did not usually have wheeze (low
sensitivity).
The GDG agreed that wheeze was too common a symptom to be moved into the ‘amber’ or ‘red’
columns. Therefore, no changes relating to wheeze were made to the traffic light table.
Chest findings/abnormal chest sounds (identified in 2013 review)
The evidence showed that children who had abnormal chest sounds were not more likely to have a
serious illness than children who did not have abnormal chest sounds (not a strong positive likelihood
ratio). In addition, the evidence showed that children without pneumonia, a urinary tract infection or
bacteraemia usually did not have abnormal chest sounds (high specificity). However, it also showed
that children with pneumonia, a urinary tract infection or bacteraemia also did not usually have
abnormal chest sounds (low sensitivity).
The GDG highlighted that ‘crackles’ was already included in the traffic light table, which was a better
defined sign than ‘chest findings’ or ‘abnormal chest sounds’. One of the studies included in the
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2013 Update