Box 4.
Scenarios rated by panellists as may be appropriate to attend emergency departmenta
| Past medical history (d) | 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 has shortness of breath combined with wheeze | ||
| If the child is less active or socially interactive than usual, has high fever, and reduced fluid intake | No consensus/normal parental decision making requiredc | ||
| If the child has ear pain, is less active or socially interactive than usual, has a high fever, and is wheezing or has ‘noisy breathing’b | |||
| Any four symptom combinations that combine both wheeze and shortness of breatha | No consensus/normal parental decision making requiredc | ||
| All symptoms | All symptomsb | ||
| If the child has high fever and reduced fluid intake combined with wheeze OR shortness of breathb | |||
| If the child has ear pain, high fever, and shortness of breathb | |||
| If the child is less active or socially interactive than usual, has high fever, and combined with wheeze OR shortness of breath | |||
| If the child has high fever, combined with shortness of breath and wheezeb | |||
| Reduced fluid intake, less active or socially interactive than usual, high fever, and wheeze OR shortness of breathb | |||
| If the child has ear pain, reduced fluid intake, high fever, and shortness of breathb | |||
| All five symptom combinationsb | |||
| Previous admission for asthma, bronchiolitis, or other respiratory condition | No consensus/normal parental decision making requiredc | If the child only has shortness of breath | |
| If the child is less active or socially interactive than usual, has high fever, and combined with wheeze OR shortness of breath | If the child is less active or socially interactive than usual, has high fever, and combined with wheeze OR has shortness of breath except when these are combined with ear pain and being less active or socially interactive than usual | ||
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).
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.