A5V4d

Clinical assessment of the child with fever
Figure 5.4 Comparison of heart rate centiles from Fleming study with heart rate ranges from the advance
paediatric life support.
Source: Fleming et al, 2011, Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a
systematic review of observational studies, The Lancet 2011; 377: 1011–18 (Reproduced with permission, Elsevier Limited)
The GDG also emphasised the difficulty of accurately measuring resting heart rate in children and that
results varied depending on equipment used, so measurement error would also be a significant issue.
For these reasons the GDG specified that heart rate should be added to the traffic light table in the
‘amber’ category, and should not be used in isolation to identify serious illness.
Using changes in heart rate adjusted for temperature to detect serious illness
The GDG concluded that the evidence on use of a combined temperature and heart rate measure did
not support its inclusion in the traffic light table as it was shown to have less diagnostic value than
either temperature or heart rate alone.
Consideration of health benefits and resource uses
The GDG emphasised that heart rate should be routinely recorded and health professionals should
have been how trained in how to do this, so there were no resource implications associated with the
implementation of this recommendation.
Quality of evidence
The available evidence was of low or very low quality due to serious illness not being fully defined, not
all children receiving the same test and children older than 5 years being included.
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2013 Update