Often simple steps can be the most effective. In children with a high temperature, checking and noting their temperature, heart rate, respiratory rate and capillary refill time can help to differentiate between serious, life threatening, illnesses such as meningitis, pneumonia and sepsis, and viral illnesses which will resolve with treatment at home.
Sadly, a recent study has discovered that children are not routinely being given all four tests. In the cases which were studied about a third of children received either no tests, or only one when seen by their GP.
It is to be hoped that the additional focus which has been placed on the importance of recognising infections as medical emergencies, by charities such as the Sepsis Trust, will bring improvements and lead to fewer preventable deaths in future.
The Nice guidance says GPs must measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever. Capillary refill is when doctors press on a patient’s nail bed and then count the seconds until it returns to its usual colour – normally under two seconds. In the study, Dr Alice Lee, from Pennine Acute Hospitals NHS Trust, looked at data for 47 under-fives in a Stockport GP practice. She found just 13% of consultations included all four checks, with about one in three children receiving no tests at all or only one.