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Emerg Med J. 2011 Sep;28(9):761-3. doi: 10.1136/emj.2010.098624. Epub 2010 Sep 3.

An evaluation of the UK National Pandemic Flu Service swine flu algorithm in hospitalised children, and comparison with the UK National Institute for Health and Clinical Excellence fever guideline.

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  • 1Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.



To evaluate the efficacy of the UK swine flu algorithm as a screening tool in unwell children, and to compare the management advice given with the National Institute for Health and Clinical Excellence (NICE) feverish illness guideline advice.


All paediatric medical admissions to the unit, with a fever and over the age of 1 year, during 2 weeks in November were analysed, and their histories were put through both the swine flu algorithm and the NICE fever guidance for the under 5s.


Of 72 patients, 71 would have had a diagnosis of swine flu had their symptoms been put through the algorithm. Two patients had confirmed swine flu on testing, and 32 patients definitely did not have swine flu. The positive predictive value of the algorithm is between 2.8% and 56.3% in this population. 39% would have been advised to have a face-to-face consultation by the NICE guidance, but would not have been advised to have an urgent consultation by the swine flu guidance. At least 79% of patients had treatments only available in hospitals.


The swine flu algorithm is of little use in differentiating unwell children, and advice given does not correlate well with that of the NICE guidance. There is a significant risk of harm with false-positive diagnoses and potential delays in appropriate treatment. The authors were unable to obtain the data and rationale behind the algorithm, and believe that this should be published. Face-to-face consultations may be the only way to ensure patient safety.

[PubMed - indexed for MEDLINE]
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