A5V4d

Clinical assessment of the child with fever
Clinical feature Sensitivity (95% CI) Specificity (95% CI)
Sunken eyes 0.75 (0.62 to 0.88) 0.52 (0.22 to 0.81)
Dry mucous membranes 0.86 (0.80 to 0.92) 0.44 (0.13 to 0.74)
Absent tears 0.63 (0.42 to 0.84) 0.68 (0.43 to 0.94)
Increased heart rate 0.52 (0.44 to 0.60) 0.58 (0.33 to 0.82)
Sunken fontanelle 0.49 (0.37 to 0.60) 0.54 (0.22 to 0.87)
Poor overall appearance 0.80 (0.57 to 1.04) 0.45 (−0.1 to 1.02)
Cool extremities 0.10–0.11 (range) 0.93–1.00 ( range)
GDG translation
The GDG recognised that dehydration is a marker of serious illness but there was a lack of evidence
to determine the difference between mild, moderate and severe dehydration. The most specific
symptoms and signs of dehydration have been highlighted for healthcare professionals to assess to
ensure a low false positive rate. The most sensitive symptoms and signs have been highlighted for
parents to assess to ensure a low false negative rate (see Chapter 10).
Recommendations
The recommendations covering assessment of dehydration are presented at the end of section 5.5.
5.5 Symptoms and signs of specific serious illnesses
Introduction
The next priority in the assessment of a child with a feverish illness is to determine the underlying
source of their illness.
The guideline is not meant to be a textbook on how to examine a child for all possible infections.
However, the scope does include ‘identification of signs and symptoms that would help to establish
the possible diagnoses and focus for infection’. The GDG focused on those serious illnesses that may
have immediate consequences to the child’s life expectancy or long-term quality of life.
The GDG looked at those symptoms and signs that are predictive of specific serious illnesses, which
are:
bacterial meningitis
septicaemia
bacteraemia
pneumonia
urinary tract infection
encephalitis (herpes simplex)
septic arthritis/osteomyelitis
Kawasaki disease.
The databases were searched and the highest evidence levels, i.e. prospective cohort studies, were
used when evidence was available. Retrospective studies were included when there is a lack of better
quality studies. The data were appraised, summarised and translated by the GDG members.
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