Fever: NICE to get guidance16 December, 2010 by: colinparker
Three years ago the National Institute for Clinical Excellence in the UK released their guidance on the assessment and initial management of feverish illness in young children (CG47). Most of the world outside of Britain has not been using this guidance, but we thought it would be useful to delve a bit deeper to see whether we could all benefit from the insights of their expert panel.
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Outline of this PEMcast
CP: Intro, hello, disclaimer
NICE CG47 Issued in May 2007, referenced in:
Richardson M, Lakhanpaul M; Guideline Development Group and the Technical Team.
Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidance.
BMJ. 2007; 334: 1163-4
Richardson M, Lakhanpaul M.
Feverish illness in children under 5 years.
Arch Dis Child Educ Pract Ed. 2008; 93: 26-9
Main part of discussion centres around NICE CG47 (Full Guideline) Section 4:
Clinical assessment of the child with fever
CP: 4.1 Introduction
SF: 4.2 Priorities in Clinical Assessment
KB: 4.3 Life-Threatening features of Illness in Children
CP: 4.4.1-4.4.2 Assessment of Risk of Serious Illness and Traffic Light system
KB: Traffic lights: green components
SF: Traffic lights: orange
CP: Traffic lights: red
All: comments & discussion on traffic light components
CP: 4.5 Non-Specific symptoms and signs of Serious Illness
SF: 4.5.1 General Symptoms and Signs
KB 4.5.2 Predictive Values of common Physiological Measurements
CP 4.5.3 Height and Duration of Fever
SF 4.5.4 Assessment of Dehydration
CP 4.6 Specific Serious Illnesses – not discussing (will discuss on future episodes though)
With reference to Quick Reference Guideline:
SF: Overview of care pathway – page 4
KB: Assessment – page 8
CP: Introduction to management remote vs normal doctor vs paediatrician
Perspective from position of:
- KB: remote assessment
- CP: non-paediatric doctor
- SF: paediatrician
Would you use the guideline, would you stick to it?
Would you feel protected if something went wrong?
CP/ All: Outcomes / impact of NICE CG47, discussion, perspective & experience from clinical experience.
Goodbye, thanks, see you next time…