Patient selection: sick child from 2 to 60 months of age
13 signs of possible severe pediatric illness:
(1) inability to drink
(2) abnormal mental status (abnormal sleepiness)
(3) convulsions
(4) wasting
(5) edema
(6) chest wall retraction while breathing
(7) stridor
(8) abnormal skin turgor
(9) repeated vomiting
(10) stiff neck
(11) a tender swelling behind the ear
(12) pallor of the conjunctiva
(13) corneal ulceration
The presence of one or more of these findings classifies the child as having severe illness and the child can be referred to for more intensive medical care.
The signs were evaluated by Paxton et al on sick children in Kenya.
Signs identified as significant for being hospitalized in a multivariate model:
(1) pallor of the conjunctiva
(2) chest wall retraction
(3) edema
(4) convulsions
(5) abnormal skin turgor
(6) repeated vomiting
Signs identified as significant for mortality:
(1) pallor of the conjunctiva
(2) abnormal mental status
(3) repeated vomiting
(4) poor skin turgor
(5) chest wall retraction
(6) edema
The mortality was 6.5 times higher for a child with one or more of these 6 signs vs a child with none of them.
