A5V4d
Share Embed Flag
Download ePaper

A5V4d

A5V4d A5V4d

rodrican
30.05.2013 Views

Feverish illness in children Research recommendations Number Research recommendation 140 Symptoms and signs of serious illness RR 2 The GDG recommends a UK-based epidemiological study on the symptoms and signs of serious illness. [new 2013]. Why this is important The current recommendations on symptoms and signs in the NICE guideline are based on a series of heterogeneous studies (using different methods, populations, outcomes and of varying quality) and a degree of subjectivity was needed to bring these together in the guideline. Therefore, the GDG recommends that a large prospective UK-wide study (n = 20,000 plus) should be undertaken comparing all of these symptoms and signs covered in the guideline. This would allow for a standardised comparison of each symptom and sign, and for validation of the existing ‘traffic light’ table. The study should use a standardised data collection protocol. Where possible the study should link with routinely collected data sets, such as Hospital Episode Statistics. The study should include a variety of settings and locations – that is, wherever children present, including primary care. The primary outcome of the study should be the final diagnosis and results of treatment. 5.6 Imported infections The management of children with imported infections is beyond the scope of this guideline. However, the GDG recognised that significant numbers of children do enter or return to the UK from overseas each year. Some of these children will have been in countries where tropical and sub-tropical infectious diseases such as malaria and typhoid fever are endemic. Accordingly, the GDG decided to make the recommendation below. Recommendations Number Recommendation Imported infections 32 When assessing a child with feverish illness, enquire about recent travel abroad and consider the possibility of imported infections according to the region visited. [2007]

6 Management by remote assessment Introduction When a concerned parent or carer decides to make contact with a healthcare professional about a feverish child, the initial contact may be by telephone and in these circumstances a remote assessment may be undertaken. In this context, ‘remote’ refers to the assessment of the child’s symptoms carried out by an assessor who is geographically remote from the child. It is common practice for remote assessment to be carried out during the out-of-hours period and, similarly, remote assessment may be a prerequisite for patients requesting an urgent in-hours appointment with their GP. Specific advice lines also exist, such as the 0845 4647 service offered by NHS Direct. * 999 calls to the ambulance service are similarly assessed in order to determine the urgency of the response required. The purpose of the remote assessment is to identify the level of care the child needs and to refer to the most appropriate location of care to meet those needs within an appropriate time frame. This process will include the identification of those with potentially life-threatening compromise to airway, breathing, circulation and level of consciousness, those with symptoms suggestive of serious illness and also identification of those children who are most likely to have a self-limiting illness and for whom care at home is the most appropriate option. The skills and experience of the healthcare professional carrying out the remote assessment will vary and their assessment may or may not be supported by decision support software or other paperbased protocols. Remote assessment can be difficult as the assessor has only the symptoms reported by the caller on which to base the assessment. An additional difficulty, particularly when assessing a small child, is that the quality of information reported by the caller is likely to be variable and may be influenced by parental/carer concern. Symptoms which concern one parent/carer may not concern another and similarly symptoms which concern a parent/carer may not be those which most concern a healthcare professional. It is essential that listening and critical thinking skills are employed throughout the assessment in order to ensure that all cues are identified and interpreted appropriately. This will include taking into account the level of parental/carer concern, the cause of which may not be easy to pinpoint. At times, however, it will be possible to identify a likely cause of the fever and that being the case the appropriate guidance for that condition should be followed. In some circumstances the child may not be geographically remote from the assessor but physical examination of the child may not fall within the scope of practice for that healthcare professional. The assessor may thus feel it is more appropriate to follow the remote assessment guidance rather than that for face-to-face assessment which takes into account signs found on physical examination. 6.1 Clinical assessment It is assumed that children with feverish illnesses undergoing a remote assessment will have a clinical assessment as described in Chapter 5. By necessity, the emphasis will be on detecting symptoms rather than physical signs. The first priority is to identify any immediately life-threatening features, including compromise of the airway, breathing, circulation and level of consciousness. Children with feverish illness should then be assessed for the presence or absence of symptoms that predict the * Please note that this service will be replaced by NHS 111, which is due to be implemented nationally in 2013. 141

Feverish illness in children<br />

Research recommendations<br />

Number Research recommendation<br />

140<br />

Symptoms and signs of serious illness<br />

RR 2 The GDG recommends a UK-based epidemiological study on the symptoms and<br />

signs of serious illness. [new 2013].<br />

Why this is important<br />

The current recommendations on symptoms and signs in the NICE guideline are<br />

based on a series of heterogeneous studies (using different methods, populations,<br />

outcomes and of varying quality) and a degree of subjectivity was needed to bring<br />

these together in the guideline. Therefore, the GDG recommends that a large<br />

prospective UK-wide study (n = 20,000 plus) should be undertaken comparing all of<br />

these symptoms and signs covered in the guideline. This would allow for a<br />

standardised comparison of each symptom and sign, and for validation of the<br />

existing ‘traffic light’ table.<br />

The study should use a standardised data collection protocol. Where possible the<br />

study should link with routinely collected data sets, such as Hospital Episode<br />

Statistics. The study should include a variety of settings and locations – that is,<br />

wherever children present, including primary care. The primary outcome of the study<br />

should be the final diagnosis and results of treatment.<br />

5.6 Imported infections<br />

The management of children with imported infections is beyond the scope of this guideline. However,<br />

the GDG recognised that significant numbers of children do enter or return to the UK from overseas<br />

each year. Some of these children will have been in countries where tropical and sub-tropical<br />

infectious diseases such as malaria and typhoid fever are endemic. Accordingly, the GDG decided to<br />

make the recommendation below.<br />

Recommendations<br />

Number Recommendation<br />

Imported infections<br />

32 When assessing a child with feverish illness, enquire about recent travel abroad and<br />

consider the possibility of imported infections according to the region visited. [2007]

logo

products

Resources

Company

Terms of service
Privacy policy
Cookie policy
Cookie settings
Imprint
Change language
Made with love in Switzerland
© 2024 Yumpu.com all rights reserved

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!