A5V4d

Weak, high-pitched or continuous cry (in 2007 traffic light table)
Clinical assessment of the child with fever
An abnormal cry was reported in three studies. One study stated that crying was not significantly
associated with bacteraemia, whilst another reported a significant odds ratio for bacteraemia in
children with an abnormal cry compared to those without an abnormal cry. One study reported low
sensitivity, specificity and positive predictive value for detecting serious bacterial infection. The
negative predictive value was high. The likelihood ratios were not strong.
Irritability (identified in 2013 review)
Irritability was reported in six studies. In two of these studies irritability was not found to be
significantly associated with bacteraemia or urinary tract infection. The other four studies reported
diagnostic accuracy data, with two of these finding a high negative predictive value for detecting
bacteraemia or bacterial meningitis. However, in the other two studies the negative predictive value
was low to moderate for detecting serious bacterial infection and viral or non-specific meningitis. The
sensitivity, specificity and positive predictive values were not high in any of the studies, and the
likelihood ratios were not strong.
Decreased consciousness and/or coma (identified in 2013 review)
Decreased consciousness and/or coma were reported in four studies, including unrousable coma.
Decreased consciousness or coma has a low sensitivity for detecting serious bacterial infection or
bacterial meningitis; however, the specificity was high. The positive and negative predictive values
ranged from high to low, and the likelihood ratios were not strong.
Restlessness (identified in 2013 review)
Restlessness was reported in one study. The sensitivity, specificity, positive predictive value and
negative predictive value were not high and the likelihood ratios were not strong for detecting serious
illness.
Respiratory
Nasal flaring (in 2007 traffic light table)
No evidence was reported on the use of nasal flaring for detecting serious illness.
Grunting (in 2007 traffic light table)
No evidence was reported on the use of grunting for detecting serious illness.
Tachypnoea (in 2007 traffic light table)
Tachypnoea was reported in two studies, including ‘elevated respiratory rate’. The sensitivity was low
and specificity was moderate for detecting pneumonia or bacteraemia. The positive predictive values
were low and the negative predictive values were high. The positive and negative likelihood ratios
were not strong.
Oxygen saturation (in 2007 traffic light table)
No evidence was reported on the use of oxygen saturation for detecting serious illness.
Moderate or severe chest indrawing (in 2007 traffic light table)
No evidence was reported on the use of chest indrawing for detecting serious illness.
Crackles (in 2007 traffic light table)
The presence of crackles was reported in two studies, including ‘abnormal chest sounds’ and
crepitation. The sensitivity was low for detecting pneumonia, urinary tract infection, bacteraemia or
serious bacterial illness. The specificity ranged from high to moderate. The positive predictive values
were low, and the negative predictive values ranged from high to low. The positive and negative
likelihood ratios were not strong.
Respiratory symptoms (identified in 2013 review)
Respiratory symptoms were reported in four studies, with definitions including respiratory distress,
breathing difficulty, shortness of breath and breathing difficulty or chest wall recession. The sensitivity
was not high or not reported for detecting urinary tract infection, pneumonia, bacteraemia, serious
illness or serious bacterial infection. The specificity ranged from high to low. The positive predictive
value was not high, and the negative predictive value ranged from high to moderate. The likelihood
ratios were either not strong or not reported.
93
2013 Update