A5V4d

Feverish illness in children
Process used for the 2013 traffic light table
The guideline update aimed to reassess the symptoms and signs contained in the 2007 traffic light
table to ensure that the evidence supporting their inclusion was up to date, and to explore whether
there was new evidence to add any symptoms and signs that were not included in the 2007 traffic
light table. The reviews focused on diagnostic usefulness of signs and symptoms. This differed from
the 2007 approach that focused on correlations between symptoms and serious illness. Therefore,
the updated reviews acted as validation of the original traffic light table.
For each symptom or sign, the data found in the 2013 review was considered along with the GDG’s
expert opinion regarding the use of a symptom or sign in current clinical practice. Based on both the
diagnostic outcome measures (positive likelihood ratio, negative likelihood ratio, sensitivity, specificity,
specificity, positive predictive value, and negative predictive value) and the GDG’s views, a decision
was made whether to: add a new symptom or sign to the traffic light table; move an existing symptom
or sign to a different column (for example, from the amber column to the red column); or remove an
existing symptom or sign from the traffic light table.
Combinations of symptoms and signs were not considered for the updated reviews as they could be
misinterpreted if they were included, and they could not easily be incorporated into the existing traffic
light table. The 2007 review on symptoms and signs of specific serious illnesses was not updated for
2013, and the original section can be found at the end of this chapter (see Section 5.4).
The update review was organised under the headings used in the 2007 traffic light table:
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colour
activity
respiratory
hydration
other.
An updated review on the Yale Observation Scale was also undertaken to ensure the evidence for its
use as the basis of the traffic light table is still valid.
To ensure the recommendations follow a logical sequence, the updated traffic light table is provided
here before the evidence and translations. The 2013 updated review is presented in Section 5.4. The
recommendations are provided towards the end of this chapter and the reader is advised to refer back
to the table whenever it is mentioned.
In summary, the updated review resulted in the following changes to the traffic light table:
‘A new lump > 2cm’ was removed from the table
‘Bile-stained vomiting’ was removed from the table
‘Age 3–6 months, temperature ≥ 39°C’ was moved from the red column to the amber
column
‘Rigors’ was added to the table, in the amber column
‘Tachycardia’ was added to the table, in the amber column.
2013 Update