Box 3:
Scenarios rated by panellists as may be appropriate to attend the GPa
| (d) Past medical history | Age | ||
|---|---|---|---|
| (a) 12–23 months | (b) 24 months–4 years and 11 months | (c) 5–12 years | |
| None (previously well aside from usual childhood illnesses) | If the child only has shortness of breathb | ||
| If the child only has high feverc | If the child only has wheezingc | No consensus was agreed/normal parental decision making requiredd | |
| If the child has ear pain and high feverc | |||
| If the child has any symptoms combined with shortness of breath, wheeze, or high fever | |||
| Any combination of 3 symptomsc | Any combination of 3 symptoms apart from: high fever, reduced fluid intake, and shortness of breathc | ||
| Combinations of 4 symptoms, where this does not include wheezing AND/OR shortness of breathb,c | |||
| If the child has 5 symptoms that do not include shortness of breath or wheezingb | |||
| Previous admission for asthma, bronchiolitis, or other respiratory condition | If the child only has wheezing | If the child only has high fever | If the child only has wheezing |
| If the child has any symptoms combined with shortness of breath, wheeze, or high fever | No consensus was agreed/normal parental decision making requiredd | If the child has any symptoms combined with shortness of breath, wheeze, or high fever | |
| Any combination of 3 symptoms apart from: less socially active than usual, high fever, and shortness of breathb | |||
| All combinations of 4 symptoms apart from: reduced fluid intake, less active or socially interactive than usual, high fever, shortness of breathb | |||
| AND reduced fluid intake, high fever, wheezing, and shortness of breathb | |||
| If the child has 5 symptoms, but does not have wheezingb | If the child has 5 symptoms that do not include shortness of breath or wheezingb | ||
After considering the clinical stem, which states: for the parent of a child aged (a) 12–23 months/(b) 24 months–4 years and 11 months/(c) 5–12 years with ≥1 week of respiratory infection symptoms, for example, cough, sore throat, and/or runny nose, with or without eating adequately and normal conscious level, and with the (d) following past medical history and (e) combination of symptoms — what would be the most appropriate next step (f) (Rate on scale 1–9 = 1 inappropriate; 9 = appropriate) (see Box 1).
ED was generally deemed more appropriate in most circumstances.
This guidance also applies to children who have previously been admitted for asthma, bronchiolitis, or another respiratory condition.
Where no consensus could be reached, the process was essentially unable to add anything to parents’ routine decision making, which therefore returns to being the default position. ED = emergency department.