A5V4d

Feverish illness in children
5.2 Life-threatening features of illness in children
Evidence was sought for symptoms and signs associated with fever which would predict serious
illness in young children.
Review question
In children with fever, what signs or combination of symptoms and signs are associated with serious
illness or mortality?
Are there any scoring systems that use symptoms and signs in children with fever to predict the risk of
serious illness? How accurate are they?
Evidence summary
Although evidence was found to determine risk factors for serious illness, none of the features in
isolation or combination were strongly associated with death.
GDG translation
The guideline development group (GDG) felt that recommending a specific list of life-threatening signs
could result in under-recognition of cases if such a list was used in isolation. Healthcare providers are
trained to follow the principles of the Resuscitation Council (UK) guidelines for resuscitation: i.e.
assessment of airway, breathing, circulation and neurological dysfunction. 92 Although the GDG could
not find any prospective comparison of using these priorities with any other resuscitation strategy,
they have been developed with widespread consultation and are seen as best practice by all those
involved in the acute management of children. The GDG agreed with stakeholder input to reinforce
the principles to determine life-threatening features. However, the GDG has not produced a specific
list of signs as this could have the result of removing the clinical judgement required to assess
whether a child has an immediate threat to life.
Recommendations
Number Recommendation
50
Life-threatening features of illness in children
7 First, healthcare professionals should identify any immediately life-threatening
features, including compromise of the airway, breathing or circulation, and
decreased level of consciousness. [2007]
5.3 Assessment of risk of serious illness
Introduction
After assessing the presence or absence of immediately life-threatening features in a child with a
fever, the next priority for the healthcare professional should be to make a further risk assessment
based on the presenting symptoms and signs. Some symptoms and signs lead towards a diagnosis of
a specific illness or focus of infection. Other symptoms and signs are non-specific but may indicate
the severity of illness. Healthcare professionals need to be able to detect those children with nonspecific
features of serious illness as well as be able to consider the working diagnosis for each case.
Healthcare professionals also need to know when to be reassured that children have a self-limiting
illness, with parents or carers needing advice and support rather than the child needing specific
treatments or admission to hospital.