A5V4d

Feverish illness in children
risk of serious illness using the traffic light system (see Table 5.2). Finally, the healthcare professional
should seek the presence of symptoms that might suggest a particular diagnosis.
6.2 Management according to risk of serious illness
Evidence summary and GDG statement
The guideline development group (GDG) sought evidence that might refer particularly to the clinical
evaluation of risk of serious illness by remote assessment or might direct management in this
situation. No additional studies were found to add to the body of evidence which is described in
Chapter 5. None of the studies found were specific to remote assessment or gave an indication of the
time frame within which interventions should occur. With the exception of studies concerning the
subjective detection of fever by parents and carers (section 4.3), no studies were found validating
symptoms reported by parents or carers on remote assessment.
In line with the evidence presented in Chapter 5, the GDG concluded that children with immediately
life-threatening features should receive emergency care. Children with ‘red’ features should be
referred for an urgent face-to-face assessment, preferably within primary care. Those with ‘amber’
features would also require a face-to-face assessment although usually there would be less urgency.
As described in Chapter 5, children with ‘green’ features only are at very low risk of serious illness
and can be cared for at home. For children requiring an urgent face-to-face assessment, the GDG felt
it was important to define the time frame within which an urgent assessment should be carried out
because children with ‘red’ features are at high risk of having a serious illness. The GDG was unable
to achieve consensus among themselves about the time limit for an urgent assessment and this
question was therefore put out to formal consensus. The GDG used the Delphi panel to establish the
definition of ‘urgent’ in the context of referral for further assessment (see section 3.2).
Delphi consensus
Background
Parents or carers often phone healthcare professionals for advice (e.g. NHS Direct, GP surgery)
when their child has a fever.
The GDG has identified a number of symptoms which may indicate SBI (such as bacterial meningitis
or pneumonia) and should prompt a 999 call. Other symptoms have been identified which warrant an
urgent referral for a face-to-face assessment.
Delphi statement 2.1
An urgent face-to-face assessment means that a child should be seen within:
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
43 (83%) 5 (10%) 1 (2%) 0 3 (6%) 52 2
In the first round consensus (83%) was reached that an urgent face-to-face assessment means that a
child should be seen within 2 hours.
Health economics
The GDG recognised that the requirement for a face-to-face assessment within 2 hours for children
with ‘red’ features may have health economic implications. In particular, the recommendation could be
seen as producing an increase in the number of children referred from remote assessment to face-toface
assessment within this timescale. A detailed justification of this recommendation on clinical and
health economic grounds was therefore developed. This is included in the guideline as Appendix E. In
summary, the GDG concluded that the recommendation on urgent assessment would not represent
an uplift in the provision of care for the following reasons:
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Children with ‘red’ features are at significant risk of serious illness and death.