A5V4d

Management by the non-paediatric practitioner
A feverish child considered to have an immediately life-threatening illness should be transferred
without delay to the care of a paediatric specialist by the most appropriate means of transport (usually
999 ambulance).
Health economics
The GDG recognised that in order to improve the NHS’s ability to detect serious illness in children, it
might be necessary to assess more, both in primary care and secondary care. The GDG also
recognised that the number of children with ‘amber’ features with no focus on infection is a small
proportion of face-to-face and remote access healthcare contacts by children with fever, and children
with ‘red’ features make up an even smaller proportion of these children. Data on this is lacking, but
the GDG consensus was that a normal GP practice will see an incidence of 1/100 children/year with
‘red’ symptoms, and a district general hospital may see three patients a week.
Attempts at modelling this were made but the number of possible variables and lack of evidence
regarding outcomes impeded these attempts (see section11.2).
GDG translation
The GDG determined that children with fever receiving non-specialist care should be referred or
allowed home according to their risk of serious illness, as defined in the traffic light table. Children
with ‘red’ features are at risk of serious illness and should usually be referred to a paediatric specialist
by the most appropriate route. Children with ‘amber’ features are at intermediate risk and should be
provided with a safety net that may also involve referral to a specialist. The decision as to what form
the safety net takes will depend on the experience, training and expertise of the non-specialist
clinician. It will also depend on the local health service configuration and the family’s social situation.
The GDG recognised that adherence to the recommendations in this section may cause changes in
referral patterns between primary and secondary care. The health economists attempted to model
these patterns but could not find sufficient evidence about current referral patterns and the associated
risks. The GDG called for research to be undertaken so that the health economic model could be
populated.
Recommendations
Number Recommendation
Management according to risk of serious illness
39 Children whose symptoms or combination of symptoms and signs suggest an
immediately life-threatening illness (see recommendation 7) should be referred
immediately for emergency medical care by the most appropriate means of
transport (usually 999 ambulance). [2007]
40 Children with any ‘red’ features but who are not considered to have an immediately
life-threatening illness should be referred urgently to the care of a paediatric
specialist. [2007]
41 If any ‘amber’ features are present and no diagnosis has been reached, provide
parents or carers with a ‘safety net’ or refer to specialist paediatric care for further
assessment. The safety net should be 1 or more of the following:
providing the parent or carer with verbal and/or written information
on warning symptoms and how further healthcare can be accessed
(see chapter 10)
arranging further follow-up at a specified time and place
liaising with other healthcare professionals, including out-of-hours
providers, to ensure direct access for the child if further assessment
is required. [2007]
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