NICE child fever guidance queried

NICE guidance on assessing children with fever has been criticised for being too reliant on the measurement of vital signs.

NICE child fever guidance queried
NICE child fever guidance queried

Writing in an editorial in the BMJ, Dr Anthony Harnden, from the department of primary care at Oxford University, said there was a lack of evidence about the use of vital signs in primary care.

NICE guidance states that measurements of vital signs such as body temperature, heart rate and respiratory rate be carried out to detect feverish illness in children.

But Dr Harnden said: ‘Chil­dren of the same age have different baseline heart rates and these rates may respond differently to fever irrespective of the severity of illness.

'Moreover, precise measurement of heart rate is difficult, especially in very young children with higher rates.'

The traffic light system proposed by NICE is also of limited value, he said.

Dr Harnden added that the best evidence of recognising clinical severity in febrile children in primary care is a full assessment by an experienced clinician.

'This involves eliciting a clear history and careful observation of signs, including alertness, activity, colour and respiratory effort,' he said.

'GPs must not be persuaded to disregard their intuition.'

Additionally, Dr Harnden said that changes in NHS policy had led to the primary care of children with fever presenting outside surgery hours being delivered by an increasing number of professional groups, such as NHS Direct and out-of-hours centres, with varying levels of skill and experience.

'To improve the care of children with feverish illness in primary care we should be offering  more opportunities for prompt clinical assessment.'

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