A5V4d

Clinical assessment of the child with fever
would communicate that they had a headache. The GDG concluded that the evidence was not strong
enough to add headache to the traffic light table.
Based on the quality of the available evidence and its discussion, the GDG decided that no changes
relating to headache were needed to the traffic light table.
Conjunctivitis (identified in 2013 review)
The evidence showed that children with conjunctivitis were not more likely to have a urinary tract
infection than children without conjunctivitis (not a strong positive likelihood ratio). In addition, the
evidence showed that children without a urinary tract infection usually did not have conjunctivitis (high
specificity). However, children with a urinary tract infection also did not usually have conjunctivitis (low
sensitivity).
The evidence for conjunctivitis was in relation to detecting urinary tract infection, and the GDG was
not convinced of a clinical link between the two conditions. Therefore, the GDG did not add
conjunctivitis to the traffic light table.
Poor peripheral circulation (identified in 2013 review)
The evidence showed that children with poor peripheral circulation were not more likely to have a
serious illness than children with normal peripheral circulation (not a strong positive likelihood ratio).
In addition, the evidence showed that children without a serious bacterial infection often had normal
peripheral circulation (moderate specificity); however, children with a serious bacterial infection also
usually had normal peripheral circulation (low sensitivity).
The GDG highlighted that capillary refill time, which acts as an indicator of poor peripheral circulation
with a recognised definition, is already included in the traffic light table. Furthermore, the evidence
was of very low quality and was limited to that of one study. In addition, poor peripheral circulation
was not defined in the study, and the evidence shows that it was not a good detector of serious
illness.
Based on the available evidence and its discussion, the GDG decided that no changes relating to
poor peripheral circulation were needed to the traffic light table.
Bulging abdomen (identified in 2013 review)
The evidence showed that children with a bulging abdomen were not more likely to have a serious
illness than children without a bulging abdomen (not a strong positive likelihood ratio). In addition, the
evidence showed that children without a serious bacterial infection often did not have a bulging
abdomen (moderate specificity); however, children with a serious bacterial infection also usually did
not have a bulging abdomen (low sensitivity).
Evidence was of very low quality and was limited to that of one study. The GDG found that the
evidence that bulging abdomen was a useful predictor of serious illness was not convincing.
Therefore, no changes relating to bulging abdomen were made to the traffic light table.
Paresis or paralysis (identified in 2013 review)
The evidence showed that children with paresis or paralysis were not more likely to have bacterial
meningitis than children without paresis or paralysis (not a strong positive likelihood ratio). In addition,
the evidence showed that children without bacterial meningitis usually did not have paresis or
paralysis (high specificity). However, children with bacterial meningitis also did not usually have
paresis or paralysis (low sensitivity).
The evidence for paresis or paralysis for detecting serious illness was of very low quality and was
limited to that of one study. The included children had all had a febrile convulsion prior to inclusion in
the studies. The GDG stated that a child with paresis or paralysis is likely to be identified using the
traffic light table under ‘appears ill to a healthcare professional’ and ‘focal neurological signs’. The
evidence was not convincing to add paresis or paralysis as an additional symptom or sign.
The GDG decided that paresis or paralysis should not be added to the traffic light table.
Abnormal neurological findings (identified in 2013 review)
The GDG stated that ‘abnormal neurological findings’ is already covered in the traffic light table under
‘focal neurological signs’ and ‘appears ill to a healthcare professional’. The new evidence was not
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2013 Update