A5V4d

Feverish illness in children
Evidence to recommendations
Relative value placed on the outcomes considered
The GDG stated that the overarching aim of the guideline was the early and accurate detection of
serious illness in children with fever. This allows for suitable treatment to begin, which will then reduce
morbidity and mortality.
Consideration of clinical benefits and harms
The GDG members stated that, to their knowledge, all the relevant available evidence had been
reviewed.
The GDG believed that some healthcare professionals think that a faster or greater decrease in
temperature after antipyretics would suggest that a serious illness is less likely. The GDG concluded
that this is not supported by evidence.
The GDG found evidence from one study showing that if a child’s Yale Observation Score was
measured before and after the use of antipyretics, the clinical features may have resolved in those
without serious illness. As the traffic light system contains many of the same features as the YOS, the
GDG believed that reassessment after antipyretics may help differentiate those with and without
serious illness. However, the GDG concluded that more research should be undertaken on this before
any recommendation could be made.
The GDG considered the possibility that antipyretics, by reducing symptoms, might ‘mask’ the severity
of a serious illness. The GDG concluded that there was insufficient evidence to make a conclusion on
this matter. The GDG stated that this question should be a priority for future research.
However, the GDG was concerned that the recommendation not to use response to antipyretics as a
diagnostic test could lead to children not being regularly reassessed, as often this was done to see if
a child had responded to antipyretics. The GDG was worried that this could lead to unnecessary
delays in treatment for children with serious illnesses. Therefore, the GDG added a caveat to the
recommendation stating that a child admitted to hospital with any amber or red features on the traffic
light table needed be regularly assessed to ensure their condition had not worsened.
Consideration of health benefits and resource uses
The GDG emphasised that antipyretics were considerably cheaper than any formal diagnostic test.
However, as the GDG concluded that antipyretics were of no diagnostic value, switching to
antipyretics from diagnostic tests would not be a cost-effective option for the NHS.
Quality of evidence
The available evidence was of very low quality due to poor study design. In addition, heterogeneity
between studies in terms of definitions of fever, disease, dosage of antipyretics, age of children and
timing of follow-up made comparison of outcomes difficult.
The studies were also relatively old and in many cases did not reflect what would be considered safe
practice in the UK, especially in relation to giving Aspirin to children as this would not be used in the
UK.
Other considerations
No equalities issue were identified in relation to this question.
Recommendation
Number Recommendation
180
Observation in hospital
Response to antipyretic medication
61 When a child has been given antipyretics, do not rely on a decrease or lack of
decrease in temperature at 1–2 hours to differentiate between serious and nonserious
illness. Nevertheless, in order to detect possible clinical deterioration, all
children in hospital with ‘amber’ or ‘red’ features should still be reassessed after 1–2
2013 Update