Quality standard
Quality statement 1: Risk of serious illness
Quality statement 1: Risk of serious illness
Quality statement
Infants and children under 5 years with unexplained fever have their risk of serious illness assessed and recorded using the traffic light system.
Rationale
The condition of an infant or child with a serious illness can deteriorate within hours of onset. It is therefore important that risk of serious illness is assessed when infants and children present to healthcare professionals with unexplained fever. The traffic light system helps healthcare professionals, in conjunction with their professional judgement and the information provided by the parents and carers, to assess the risk of serious illness in a child with unexplained fever.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that healthcare professionals are using the traffic light system to assess and record the risk of serious illness in infants and children under 5 years presenting with unexplained fever.
Data source: Local data collection.
Process
Proportion of infants and children under 5 years with unexplained fever who have their risk of serious illness assessed and recorded using the traffic light system.
Numerator – the number in the denominator who have their risk of serious illness assessed and recorded using the traffic light system.
Denominator – the number of infants and children under 5 years with unexplained fever.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as general practice and emergency departments) ensure that healthcare professionals assess and record the risk of serious illness using the traffic light system in infants and children under 5 years with unexplained fever.
Healthcare professionals ensure that they assess and record the risk of serious illness using the traffic light system in infants and children under 5 years with unexplained fever.
Commissioners (clinical commissioning groups and NHS England) ensure that the services they commission can demonstrate the use of the traffic light system to assess and record the risk of serious illness in infants and children under 5 years with unexplained fever (for example, through auditing).
Infants and children under 5 years with unexplained fever have their risk of serious illness assessed and recorded by a healthcare professional using a system that groups signs and symptoms into high (red), medium (amber) and low (green) risk. This is called the traffic light system.
Source guidance
Fever in under 5s: assessment and initial management. NICE guideline NG143 (2019, updated 2021), recommendation 1.2.3
Definitions of terms used in this quality statement
Fever
Fever is an elevation of body temperature above the normal daily variation. Healthcare professionals should take any parental reports of suspected fever seriously. [NICE's 2013 full guideline on fever in under 5s, section 1.2 definitions]
Serious illness
An illness that could cause death or disability if there were a delay in diagnosis and treatment. [NICE's 2013 full guideline on fever in under 5s, section 1.2 definitions]
Traffic light system
A system that stratifies risk of serious illness in infants and children under 5 years with fever according to vital signs and clinical symptoms.
Infants and children under 5 years with fever and any of the 'red' symptoms or signs should be recognised as at high risk. Infants and children under 5 years with fever and any of the 'amber' symptoms or signs should be recognised as at intermediate risk. Those with only 'green' symptoms and signs are at low risk. The management of fever in infants and children under 5 years should be directed by the level of risk.
Vital signs can be measured only during face-to-face contact. If an infant or child's condition is being assessed remotely this will rely on identifying symptoms rather than measuring vital signs.
The traffic light system can be found in table 2 of NICE's guideline on fever in under 5s. [Adapted from NICE's guideline on fever in under 5s]
Equality and diversity considerations
Care should be taken when using the traffic light system to assess the risk of serious illness in children with unexplained fever who have learning disabilities, autism spectrum disorder or other mental health problems. This is because it may not be possible to apply all parts of the system to these children.
It may be difficult to assess pallor or a pale, mottled, ashen or blue appearance in infants and children with darker skin. Healthcare professionals should be aware that it may be easier to assess pallor on the lips or tongue.
A non-blanching rash may also be harder to detect in infants and children with darker skin tones, and healthcare professionals should be aware that it may be easier to identify a rash on the palms of the hands, the conjunctivae and the soles of the feet.
Care should be taken when assessing infants and children remotely when their parent's or carer's first language is not English. Efforts should be made to provide an interpreter and for the infant or child to be seen in person.
Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes. [NICE's guideline on fever in under 5s, recommendation 1.2.28]