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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]