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Identification and treatment of paediatric sepsis: getting the balance right
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  • Published on:
    Not so NICE guidelines
    • Anthony Cohn, Consultant Paediatrician Watford General Hospital

    Carter et al1 present interesting results which are anecdotally replicated by our local experience and is likely to be played out on a daily basis throughout the country. They conclude that there is a benefit of having senior doctors on the front line at all times when following the NICE guidelines as the majority of febrile children can be safely managed expectantly rather than with tests and treatments with a significant cost and convenience benefit. Whilst no one would doubt the benefit of having experienced doctors on the front line as much as possible- this is often not always practical given the current workforce situation.

    A different interpretation would be that this study shows that if the NICE guidelines were followed without senior involvement over 75% of children with fever would be subject to unnecessary investigations and treatment with the attendant risks – physical, experiential and financial to both patients and system. This study shows that widespread deviation from the basic guideline is safe and prudent.

    Recognising a sick child is hard whereas recognising a child who is going to become sick is almost impossible as illustrated by the numerous attempts to provide a scoring system or table that might do this. Illness is a process and each child will present at different stages. Paediatricians may be divided into those who have never sent home a child that has returned moribund or worse a few days later and those who have not done so yet....

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    Conflict of Interest:
    None declared.