Practice Guidelines

Assessment and initial management of feverish illness in children younger than 5 years: summary of updated NICE guidance

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2866 (Published 22 May 2013) Cite this as: BMJ 2013;346:f2866
  1. Ella Fields, research fellow1,
  2. Jiri Chard, senior research fellow1,
  3. M Stephen Murphy, clinical co-director1,
  4. Martin Richardson, consultant paediatrician2
  5. on behalf of the Guideline Development Group and technical team
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA, UK
  2. 2Peterborough and Stamford Hospitals Foundation Trust, Peterborough PE3 9GZ, UK
  1. Correspondence to: J Chard jchard{at}ncc-wch.org.uk

Among children presenting with fever, especially in a primary care setting, serious illness is uncommon. The prevalence of serious illness has been reported at 0.8% in primary care1 and 7.2% in secondary care.2 For this reason it is important that guidance is available to help healthcare professionals distinguish the many who have minor transient conditions from the occasional child with a serious or even life threatening infection. This article summarises the key recommendations from the 2013 update of the National Institute for Health and Care Excellence (NICE) guidelines on feverish illness in children.3

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost-effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s (GDG) experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.

Clinical assessment of feverish children

  • This should consist of three stages:

    • - Identify life threatening features (airway, breathing, circulation, disability). If any are present, refer immediately for emergency medical care. [Based on high to very low quality evidence from observational studies, and the experience and opinion of the GDG]

    • - Use the “traffic light” table (fig 1) to assess the risk of serious illness as being low (green), intermediate (amber), or high (red). (Updated recommendation with substantive changes, including addition of tachycardia as a risk factor for serious illness.) [Based on high to very low quality evidence from observational studies, and the experience and opinion of the GDG]

    • - Attempt to identify a focus of infection or features of specific serious conditions (see table). [Based on high to very low quality evidence from observational studies, and the experience and opinion of the GDG]

Fig 1 “Traffic light” table for assessing …

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