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NICE rejects call to revise traffic light system for febrile children

NICE has rejected the recommendations of a major validation study criticising its traffic light system for missing too many bacterial infections in febrile children in the latest update to its guidance published today.

The Australian study – the first major validation study for the traffic light system – found that green-amber-red tool missed one in five urinary tract infections in children.

They recommended that urine analysis should be done routinely in every child with fever and suspected bacterial infection, but NICE has not adopted this advice in the updated guideline published today.

NICE did add children with tachycardia as an ‘intermediate risk group’ for serious illness and recommended GPs used the Advanced Paediatric Life Support (APLS) criteria to define tachycardia.

It also revised the rules for the use of antipyretics, advising that GPs recommend the use of paracetamol or ibuprofen in children with fever only as long as the child ‘appears distressed’ and not to give the drugs simultaneously.

Dr John Crimmins, a GP in the Vale of Glamorgan and a member of the guideline development group at NICE, said: ‘While dealing with children with fever is an everyday encounter in general practice, identifying the small number of those children who are in the early stages of a serious bacterial illness remains a difficult and challenging problem.

‘This guideline will provide help and guidance based on the best currently available evidence, to ensure that early assessment wherever performed, can identify those children who are likely to have a serious bacterial infection and to ensure they are managed effectively, usually by referral for expert paediatric care.’

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