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Table 2 Guidelines for management of acute febrile illnesses in childrena

From: Performance of prediction rules and guidelines in detecting serious bacterial infections among Tanzanian febrile children

Name of guideline Age Group Clinical and laboratory features Publication
IMCI 2 m-5y CNS Hydration/ nutrition Respiratory Other  
 Danger signs   - Lethargic or unconscious
-h/o convulsions or currently seizing
-stiff neck
- Vomits everything
-Unable to drink/ breastfeed
-Severe malnutrition AND medical complications OR feeding issue
-Severe dehydration (Two of the following)
--Lethargic or unconscious
--Sunken eyes
--Not able to drink or drinking poorly
--Reduced skin turgor
- Stridor in a calm child
-SaO2 < 90% on RA (if available)
-Chest indrawing and HIV positive
-Tender swelling behind ear
-Severe palmar pallor
-Severe complicated measles
WHO [7]
 Indications for antibiotic treatment    -Uncomplicated severe malnutrition -Cough and tachypnea and/or chest indrawing after trial of bronchodilator (2-12 m: RR > 50/min; ≥12 m: RR >  40/min) -Ear pain or ear discharge < 14 days
-Blood in stool
 
If yes to any of the danger signs: referral and IM antibiotics
If yes to any of the antibiotic signs: oral antibiotic treatment
 
iCCM 2 m-5y CNS Hydration/ nutrition Respiratory Other  
 Danger signs   - Lethargic or unconscious
-h/o convulsions or currently seizing
-Vomits everything
-Unable to drink/ breastfeed
-Severe malnutrition (low MUAC or bilateral edema)
-Chest indrawing -HIV positive
-Blood in stool
WHO [40]
 Indications for antibiotic treatment     -Cough and tachypnea
(2-12 m: RR > 50/min; ≥12 m: > 40/min)
  
If yes to any of the antibiotic signs; oral antibiotic treatment
If yes to any of the danger signs: referral and oral antibiotics
 
ALMANACH 2 m-5y CNS Hydration/ nutrition Respiratory Other  
 Danger signs   - Lethargic or unconscious
-h/o convulsions or currently seizing
-stiff neck
-Vomits everything
-Unable to drink/ breastfeed
-Severe wasting
-Severe dehydration (Two of the following)
--Lethargic or unconscious
--Sunken eyes
--Not able to drink or drinking poorly
--Reduced skin turgor
-Chest indrawing
-Stridor in a calm child
-Cyanosis
-Tender swelling behind ear
-Severe pallor
-Jaundice
-Severe soft tissue infection
Rambaud-Althaus et al. [9]
 Indications for antibiotic treatment     Cough and RR > 50/min Acute ear discharge
Blood in stool
Urine dipstick (Positive leucocyte or nitrite)
Abdominal tenderness
 
If yes to any of the antibiotic signs; oral antibiotic treatment
If yes to any of the danger signs: referral and IM antibiotics
 
NICE traffic light system 0-5y Color Activity Respiratory Circulation and Hydration Other NICE: Feverish Illness in Children [26]
 Red- high risk   - Pale/mottled/
Ashen/blue
-No response to social cues
-Appears ill to healthcare professional
-Does not wake or if roused does not stay awake
-Weak high-pitched or continuous cry
- Grunting
- RR > 60/min
- Moderate/severe chest indrawing
- Reduced skin turgor - Age 0-3 m & T ≥ 38 °C
- Non-blanching rash
- Bulging fontanel
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
 
 Amber- intermediate risk   - Pallor - Not responding normally to social cues
- Wakes only with prolonged stimulation
- Decreased activity
- No smile
- Nasal flaring
- Tachypnea
(6-12 m: RR > 50/min; > 12 m: >  40/min)
- SaO2 ≤ 95%
- Crackles
-Tachycardia(< 12 m: > 160 bpm; 12-24 m: > 150 bpm; 2-5y: > 140 bpm)- Dry mucous membranes
- Poor feeding in infants
- CRT ≥ 3 s
- Reduced urine output
- fever ≥5 days
- swelling of a limb or joint
- non-weight bearing limb/not using
extremity
- age 3-6 m, T ≥ 39 °C
 
 Values   If yes to any of these 5 categories, each scoring 2 to 13 features  
American Academy of Emergency Physicians Guidelines 3–36 m Ill appearing Positive chest radiography (to be obtained if:T ≥ 39 °Cand WBC > 20 K/mm3 or “clinical evidence of lower respiratory infection” Positive urine leucocyte + nitrite (to be obtained in male < 1 year and female < 2 year) T ≥ 39 °C
And WBC > 15 K/mm3
American Academy of Emergency Physicians [27]
 Values   If yes to any of these features  
  1. bpm Beats per minute, CRT Capillary refill time, CRP C-reactive protein, h/o History of, m Months, SaO2 Oxygen saturation, PCT Procalcitonin, RR Respiratory rate, T Body temperature, Y Yes, y Years, WBC White blood cell count
  2. aModified and appended from Verbakel et al. [33]