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An evaluation of the UK national pandemic flu algorithm among paediatric emergency admissions, and comparison with the National Institute of Clinical Excellence fever guideline
  1. Chantelle Mann

Abstract

Aim To evaluate the efficacy of the UK Swine Flu Algorithm as a screening tool in a population of unwell children, and to compare the management advice given by the Swine Flu algorithm to that advice from the National Institute of Clinical Excellence (NICE) feverish illness guideline.

Method We analysed all emergency paediatric medical admissions with a fever, over the age of 1 year, to our unit during 2 calendar weeks in November (n=72). We retrospectively applied both the Swine Flu Algorithm and the NICE fever guidance for the under 5s.

Results 71 of 72 children would have had a diagnosis of swine flu according to the Flu Algorithm. Two patients had confirmed swine flu on testing, and 32 patients definitely did not have swine flu. Positive predictive value of the algorithm is therefore between 2.8% and 54.9% in this population. Of 57 under 5 s, 22 children would have been advised to have a face to face consultation by the NICE guidance, who would not have been advised an urgent consultation by the Swine Flu guidance. At least 79% of patients had treatments only available in hospitals.

Conclusions The Swine Flu algorithm is of little use in distinguishing children sick enough to be admitted to hospital. The advice given correlates poorly with that of the NICE feverish illness guideline. With this level of false positive diagnoses, there is a significant risk of harm, and potential delays in commencing appropriate treatment. We were unable to obtain the data and rationale behind the algorithm, and believe that this should be published. Where the construction of a clinically safe algorithm proves impossible, then although inconvenient, face to face emergency consultations may be the only way to reliably ensure the safety of our patients.

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