A5V4d

GDG translation
Clinical assessment of the child with fever
None of the signs for pneumonia are diagnostic in isolation. Not all of the signs found in the evidence
were appropriate to the UK population. The GDG considered a respiratory rate of
> 60 breaths/minute, moderate/severe chest indrawing, ‘ashen’ or ‘blue’ skin colour and grunting as
being ‘red’ features. The GDG considered tachypnoea, nasal flaring and oxygen saturations ≤ 95% in
air as being ‘amber’ features.
Recommendations
The recommendations covering pneumonia are presented at the end of section 5.5.
Urinary tract infection
Refer to the NICE Urinary Tract Infection in Children (UTIC) guideline for the summary of evidence
and translation.
The recommendations below have been adapted from the NICE UTIC guideline as the scope of the
two guidelines overlapped. The recommendation for children over 3 months has been altered as the
population for whom this guideline applies all have a feverish illness.
Recommendations
The recommendations covering urinary tract infection are presented at the end of section 5.5.
Septic arthritis/osteomyelitis
Narrative evidence and summary
One EL 2+ prospective validation US study 145 of a clinical decision rule for a septic hip that recruited
51 children (age not specified) with septic arthritis was found. The study used two clinical features
(fever and ability to bear weight on affected limb) and two laboratory features (erythrocyte
sedimentation rate (ESR) and white blood cell count (WBC)). These performed well when all the
features were available to assess. It was felt that the evidence for using the signs without blood tests
was inadequate to base recommendations upon, and thus retrospective studies were searched for.
Three EL 3 retrospective studies for osteomyelitis/septic arthritis 146–148 conducted in Taiwan ,146
Malaysia 147 and Nigeria 148 were found. The extra signs detected by retrospective studies were
swelling of an affected limb and the limb not being used.
GDG translation
Recommendations have only been made for the clinical features, as definitive diagnosis of septic
arthritis and/or osteomyelitis is beyond the scope of the guideline. The GDG considered non-weight
bearing, swelling of a limb or joint and not using an extremity as being ‘amber’ features.
Recommendations
The recommendations covering septic arthritis/osteomyelitis are presented at the end of section 5.5.
Kawasaki disease
Narrative evidence and summary
No prospective studies looking at clinical features that are predictive of Kawasaki disease were found
and thus retrospective studies from the past 10 years were searched for.
The two EL 3 retrospective studies 149,150 identified used the American Heart Association (AHA) criteria
to determine the diagnosis of Kawasaki disease. These studies went on to look at the frequency of
these features in children diagnosed with Kawasaki disease. The findings of these studies did not
change the AHA criteria.
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