A5V4d

Management by the paediatric specialist
8.6 Admission to and discharge from hospital
Admission to hospital is frightening for many young children and disruptive for their families. A child
with fever should only be admitted to hospital when absolutely necessary. Some conditions require
frequent monitoring and treatment adjustments, which can only be done in hospital. Other conditions
may be managed at home, sometimes with community healthcare support, such as ‘Hospital at
Home’ schemes. The ability to manage a child at home will vary according to local facilities. The
conditions that need admission to hospital will therefore vary.
Factors other than the child’s clinical condition can also influence the decision to admit a child with
fever to hospital. These will include particular risk factors, such as travel to an area where malaria
occurs, the family’s previous experience of illness and the ability of the family to return if their child’s
condition worsens.
Review question
What factors other than the child’s clinical condition should be considered when deciding to admit a
child with fever to hospital?
Evidence summary
No evidence was found about when to admit children with fever to hospital.
GDG statement
The GDG agreed that the decision to admit or discharge a child with feverish illness should be made
on the basis of clinical acumen after the child has been assessed (or reassessed) for the features of
serious illness (i.e. ‘red’ or ‘amber’) and taking into account the results of investigations. The GDG
also recognised that personal and social factors should also be taken into account when deciding
whether or not to admit a child with fever to hospital. In the absence of evidence as to what these
factors should be, the GDG decided it was appropriate to use the Delphi technique to inform the
recommendation on admission to hospital.
When a child has a fever and no features of serious illness it is not usually necessary or appropriate
for them to be cared for in hospital. However, there are circumstances where healthcare professionals
should consider things apart from the child’s clinical condition when deciding whether or not a child
needs to be admitted to hospital, especially if alternative support systems, such as children’s
community nurses, are not available. No evidence was available for this topic. The GDG therefore
used the Delphi panel to help produce broadly applicable recommendations in this area (see section
3.2).
Delphi statement 6
Healthcare professionals should consider the following factors, as well as the child’s clinical condition,
when deciding whether to admit a child with fever to hospital.
6.a Social and family circumstances
First round
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
7 (13%) 20 (38%) 25 (47%) 1 (2%) 53 6
Second round
1 to 3 4 to 6 7 to 9 Don’t know Missing Total Median
2 (4%) 17 (33%) 33 (64%) 52 7
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