A5V4d

Management by remote assessment
The traffic light system would encourage the referral of children with ‘red’ features for
urgent assessment while discouraging the referral of the much larger number of children
with ‘green’ features and most children with ‘amber’ features.
2 hours is an existing standard for referral for face-to-face assessment by out-of-hours
providers and NHS Direct. *
Fewer than 3% children undergoing remote assessment are likely to have ‘red’ features.
At present a greater proportion of children with fever undergoing assessment by NHS
Direct* are referred for urgent consultation.
GDG translation
The GDG recognised that remote assessment of symptoms and signs can be difficult as the quality of
the information provided can vary.
However, some children will need an immediate assessment in view of the serious nature of the
symptoms or combination of symptoms reported.
Other children will need an urgent face-to-face review by a healthcare professional who can examine
the child.
The GDG felt it was not appropriate to identify individual symptoms as immediately life threatening
because healthcare professionals will need to make a judgment in individual cases, based on the
overall picture described.
As a result of stakeholder feedback and to ensure clarity of the recommendation, the GDG made the
decision to combine the recommendation about which children should have an urgent face-to-face
assessment and the recommendation about the time frame within which that assessment should take
place into a single recommendation.
The GDG recognised that owing to the limitations of remote assessment, some children who are not
seriously ill will be referred for urgent face-to-face assessment based on symptoms reported but not
subsequently confirmed on examination. Nevertheless, the health economic analysis suggested that
the recommendation of a 2 hour limit for urgent assessment could save lives and would not present
an undue burden to the health service.
The GDG recognised that there have been no prognostic or validation studies on the predictive value
of symptoms reported to remote assessors in children with feverish illness. It was therefore decided to
call for research in this area.
Recommendations
Number Recommendation
Management according to risk of serious illness
33 Healthcare professionals performing a remote assessment of a child with fever
should seek to identify symptoms and signs of serious illness and specific diseases
as described in chapter 5 and summarised in tables 5.2 and 5.63. [2007]
34 Children whose symptoms or combination of symptoms suggest an immediately lifethreatening
illness (see recommendation 7) should be referred immediately for
emergency medical care by the most appropriate means of transport (usually 999
ambulance). [2007]
35 Children with any ‘red’ features but who are not considered to have an immediately
life-threatening illness should be urgently assessed by a healthcare professional in a
face-to-face setting within 2 hours. [2007]
* Please note that this service will be replaced by NHS 111, which is due to be implemented nationally in 2013.
143