A5V4d

Clinical assessment of the child with fever
Crain et al., 1982; Crocker et al., 1985; Factor et al., 2001; Galetto-Lacour et al., 2003; Ghotbi et al.,
2009; Haddon et al., 1999; Hewson et al., 2000; Hsiao et al., 2006; Lacour et al., 2001; Morris et al.,
2007; McCarthy et al., 1985; Nademi et al., 2001; Newman et al., 2002; Nielsen et al., 2001; Nijman
et al., 2001; Owusu-Ofori et al., 2004; Pantell et al., 2004; Pratt et al., 2007; Rabasa Al et al., 2009;
Rudinsky et al., 2009; Salleeh et al., 2010; Shaw et al., 1998; Shettigar et al., 2011; Shin et al., 2009;
Singhi et al., 1992; Tal et al., 1997; Taylor et al., 1995; Thompson et al., 2009; Trautner et al., 2006;
Weber et al., 2003; Wells et al., 2001; Yeboah-Antwi et al., 2008; YICSSG, 2008; Zorc et al., 2005) 17
were retrospective (Alpert et al., 1990; Batra et al., 2011; Bleeker et al., 2001; Bonadio et al., 1994;
Chen et al., 2009; Fouzas et al., 2010; Gomez et al., 2010; Gomez et al., 2012; Joffe et al., 1983;
Nguyen et al., 2002; Offringa et al., 1992; Olaciregui et al., 2009; Schwartz et al., 2009; Stanley et al.,
2005; Stathakis et al., 2007; Teach et al., 1997; Zarkesh et al., 2011) and two studies used data that
was collected both prospectively and retrospectively (Mandl et al., 1997;Maniaci et al., 2008).
The smallest study included 92 children (Offringa et al., 2002) and the largest study included 12,807
children (Craig et al., 2010). Studies reported on children of a variety of age ranges, and some studies
included children older than 5 years. The settings of the studies varied, including GP surgeries,
emergency departments and paediatric wards of general hospitals, emergency departments of
paediatric hospitals, tertiary care paediatric units and tertiary care medical centres. The definition of
fever used for inclusion ranged from higher than 37.2°C to higher than 41.1°C.
Some of the studies looked at specific illnesses, including bacterial meningitis, bacteraemia, urinary
tract infection, pneumonia, meningococcal disease and salmonella enteritis. Some studies looked at a
group of diagnoses, for example ‘serious illness’ or ‘serious bacterial infection’.
Twenty-one of the studies were undertaken in the USA (Alpert et al., 1990; Baker et al., 1989; Baskin
et al., 1992; Bonadio et al., 1994; Crain et al., 1982; Crocker et al., 1985; Hsiao et al., 2006; Joffe et
al., 1983; Mandl et al., 1997; Maniaci et al., 2008; McCarthy et al., 1985; Newman et al., 2002;
Nguyen et al., 1984; Pantell et al., 2004; Pratt et al., 2007; Rudinsky et al., 2009; Shaw et al., 1998;
Stanley et al., 2005; Teach et al., 1997; Trautner et al., 2006; Zorc et al., 2005), five in Australia
(Craig et al., 2010; Haddon et al., 1999; Hewson et al., 2000; Stathakis et al, 2007; Taylor et al.,
1995), five in the Netherlands (Berger et al., 1996; Bleeker et al., 2001; Bleeker et al., 2007; Nijman et
al., 2011; Offringa et al., 1992), four in the UK (Brent et al., 2011; Nademi et al., 2001; Thompson et
al., 2009; Wells et al., 2001), three in India (Batra et al., 2011; Shettigar et al., 2011; Singhi et al.,
1992), three in Spain (Gomez et al., 2010; Gomez et al., 2012; Olaciregui et al., 2009), two each in
Switzerland (Galetto-Lacour et al., 2003; Lacour et al., 2001), Ghana (Owusu-Ofori et al., 2004;
Yeboah-Antwi et al., 2008), Nigeria (Akpede et al., 1992; Rabasa Al et al., 2009), Israel (Schwartz et
al., 2009; Tal et al., 1997), and Iran (Ghotbi et al., 2009; Zarkesh et al., 2011), and one each in
Bangladesh (Factor et al., 2001), Canada (Salleeh et al., 2010), Denmark (Nielsen et al., 2001),
Greece (Fouzas et al., 2010), Italy (Andreola et al., 2007), Papua New Guinea (Morris et al., 2007),
South Korea (Shin et al., 2009) and Taiwan (Chen et al., 2009). One study was conducted in
Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa (YICSSG, 2008) and another in
Ethiopia, the Gambia, Papua New Guinea and the Philippines (Weber et al., 2003).
Twelve studies were found that reported evidence on the Yale Observational Scale (Andreola et al.,
2007; Baker et al., 1990; Bang et al., 2009; Galetto-Lacour et al., 2003; Haddon et al., 1999; Hsiao et
al., 2006; McCarthy et al., 1980; McCarthy et al., 1981; McCarthy et al., 1982; Teach et al., 1995;
Thayyil et al., 2005; Zorc et al., 1995).
More details on each individual study can be found in the evidence tables.
The GDG is aware of an HTA relevant to this review (Thompson et al., 2012). However, the review
was completed before the HTA was published. All relevant studies cited in the HTA were included in
this review.
Evidence profiles
The GRADE profiles in the tables that follow show results of included studies for various aspects of
the review question.
Table 5.3 – evaluation of colour
Table 5.4 – evaluation of social cues
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2013 Update