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New priority system released in response to 'considerable variation' in care

Traffic light fever check

NICE has developed a 'traffic light' system for assessing children with fever in a bid to challenge what it describes as 'considerable variation' in practice.

The institute insisted the guidance was necessary after uncovering evidence of a link between deaths from infection and 'deficiencies in health care'.

Children in deprived areas were at particular risk of deaths from infectious disease, the institute warned.

There was a mixed reaction from GPs, with one rejecting the draft document as 'simplistic'. But the Medical Defence Union said it could play an important role in reducing the risk of claims over missed diagnoses of meningococcal disease.

The guidance recommends treatment on the basis of symptoms classified as green, amber or red. It also outlines when GPs should provide or withhold antibiotics – as in children with fever without focus.

The guidance urges parenteral antibiotics for all children with suspected meningococcal disease, overriding recent controversy about their use.

But it leaves itself open to criticism after ignoring recent evidence on early signs of meningococcal disease such as cold hands and feet, sticking instead to the 'classic three' signs – neck stiffness, bulging fontan-elle and decreased conscious level.

NICE also faced accusations it was pandering to the worried well, after insisting GPs should 'consider valid' parental perceptions of their children's fever.

The MDU said it paid out more on behalf of GPs for missed or late diagnosis of meningococcal disease than for any other category of claim, and that the new guidance could help.

But Dr Ian Hume, chair of Norfolk LMC, said: 'It can be simplistic to replace clinical acumen with guidelines.'

The draft guidance will be under consultation until 18 January 2007.

• For guidelines and evidence-based medicine – go to

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