A5V4d

Feverish illness in children
Observation in hospital
176
testing for urinary tract infection. * [2007]
Children with fever are often observed in hospital for a period of time to help differentiate those with
serious illness from those with non-serious illness. This observation usually involves the repeated
measurement of ‘vital signs’ such as heart rate, respiratory rate and temperature, as well as repeated
assessments of the child to look for the development of any clinical features that would give cause for
concern. Investigations, if indicated, can also be done and their results sometimes obtained during a
period of observation.
Review question
In a child with fever what are the benefits, if any, of a period of observation on an assessment facility?
GDG statement
The GDG found limited research to show the overall benefits of a period of observation in the
paediatric assessment unit of the child with fever, in terms of cases of serious illness identified,
hospital admission, morbidity, mortality and recovery. Delphi consensus (see section 3.2) was sought
in an attempt to answer the question as to whether or not observation itself can help to differentiate
feverish children with non-serious and serious illness. In addition, the Delphi panel were asked to
decide how long such a period of observation should be.
Delphi statement 5.1
A period of observation in hospital (with or without investigations) as part of an assessment can help
differentiate minor from serious bacterial illness (such as bacterial meningitis or pneumonia) in a
young child who has a fever without obvious cause.
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
0 6 (12%) 44 (85%) 2 (4%) 52 8
Delphi statement 5.2
The period of observation in a hospital to help differentiate minor from serious illness in a young child
over 3 months of age with fever without obvious cause should be approximately:
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
1 (2%) 3 (6%) 26 (50%) 10 (19%) 12 (23%) 52 6
There was 85% agreement (consensus achieved) for Statement 5.1 but no consensus reached for
Statement 5.2.
GDG translation
The GDG accepted that Delphi consensus agreeing that a period of observation of young children
with fever in hospital was useful in differentiating those with minor illness from those with serious
illness. The GDG believes that this period of observation is likely to be cost-effective for the NHS
since the cost of observation is outweighed by savings from preventing unnecessary diagnostic tests
from being undertaken in children with minor illness. The GDG acknowledged that no evidence was
found nor consensus reached to determine the ideal duration of such a period of observation. Since
febrile infants less than 3 months of age have an increased risk of SBI which can be missed by
observation alone, the guideline does not suggest observation alone in this age group.
* See Urinary tract infection in children, NICE clinical guideline 54 (2007)