The Launceston General Hospital utilises the Paediatric Early Warning Tool to document vital signs and flag abnormalities
that the triage nurse should consider at the time of assessment and provide guidance in the level of care the child may require. A childhood early warning tool (CEWT) score can be applied and identifies those children at risk of more serious illness. Furthermore, it categorises age groups of children (0 to 1 years, 1 to 4 years, and 5 to 9 years) allowing for variances in normal parameters in children of different ages.
In coordination with this, the National Institute for Health and Care Excellence (NICE) (2007) describes a ‘traffic light’ system that identifies the ‘at risk’ child and can guide other methods of assessment to flag the unwell child. Parameters are consistent with those offered in the paediatric early warning tool adopted by the Launceston General Hospital.
See Table 1: (on the next page) Taking a thorough history and listening seriously to the concerned parent is important to determine risk factors for a more serious condition other than a simple fever. Fever can be harmful in people with
neurological insults (Thompson & Kagan 2010), suppressed immunity, congenital heart disease, head injury or sickle cell
anaemia (Broom 2007) and should expedite care. The duration of the fever, other signs and symptoms and care already attempted by parents such as the administration of antipyretics including time and dosages should be considered.
Febrile convulsions are a fear for both nurses and parents and should be taken seriously when taking a history from
parents. While research states febrile convulsions are probably related to rapidly ascending temperatures (Warwick 2008), children who have experienced febrile convulsions previously are more at risk of further febrile convulsions (Glatstein & Scolnik 2008). The triage nurse should therefore be well educated about the myths surrounding febrile convulsions and be able to provide accurate assessment and education.