Guidelines endorsed by RCPCH - Emergency medicine

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following publications will be of interest to paediatricians working in emergency medicine.

The following have been endorsed or supported by the College:

Endorsed guidelines

Abusive Head Trauma and the Eye in Infancy (RCOphth-RCPCH)

This guidance update is a joint venture between the Royal College of Ophthalmologists (RCOphth) and the Royal College of Paediatricians and Child Health (RCPCH). The update is restricted to a target population of children under 3 years of age suspected of being subject to abusive head trauma (AHT).

This guidance covers a review of the existing literature on AHT and the eye to supplement and update previous publications produced by RCO. This guidance also identifies areas of good practice in the management of cases referred with suspected AHT and encourage evidence based standardized assessment of such children. The guidance includes a standardised proforma for documenting retinal findings.

Date of Publication: June 2013
Date of Endorsement: June 2013

Full guidance (PDF, 1408KB, 106 Pages)
Standardised proforma (PDF, 748KB, 2 Pages)
 

Alcohol Use Disorders: Physical Complications (NICE)

This guideline covers the management of acute alcohol withdrawal, lack of thiamine, liver disease and inflammation of the pancreas in adults and young people over the age of 10 years.

The guideline is accompanied by a quick reference guide, algorithm, baseline assessment tool, costing template, audit support, costing report and a slide set.

Date of Publication: June 2010
Date of Endorsement: September 2010

Full guideline (PDF, 2.97MB, 295)
NICE guideline (PDF, 471KB, 30)
 

Allergy Care Pathways (RCPCH)

The RCPCH has developed care pathways for children with allergic conditions following the Department of Health publication on the "Review of allergy services" (2006).  These can be dowloaded below.

  • Anaphylaxis
  • Food allergy
  • Asthma/Rhinitis
  • Eczema
  • Urticaria/Mastocytosis/Angio-oedema
  • Drug allergy
  • Venom allergy
  • Latex allergy

Further information including leaflets and videos for families can be found here:

www.rcpch.ac.uk/allergy
 

Anaphylaxis (NICE)

This guideline concerns assessment with a view to confirming an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode. The patient groups covered by the guideline are adults, young people and children who receive emergency treatment for suspected anaphylaxis.

RCPCH notes:

The College asks members to note that:

The scope of the guideline covers confirmation of an anaphylactic reaction in an emergency setting and subsequent referral. As such the scope is quite narrow and excludes longer-term management of children who have experienced an anaphylactic episode (e.g. management through diet). Management of associated co-morbidities with anaphylaxis, such as asthma are also not included in the scope of the guideline. NICE however do refer readers to their related Food Allergy in Children and Young People guideline for information on allergy diagnosis and assessment. 

Date of Publication: December 2011
Date of Endorsement: March 2012

NICE guideline (PDF, 164KB, 25 Pages)
Appendices
 

Antibiotics for neonatal infection (NICE)

Neonatal infection is a significant cause of mortality and morbidity in newborn babies, and may be early-onset or late-onset. Neonatal infection can lead to life-threatening sepsis and accounts for 10% of all neonatal mortality. 
 
This quality standard covers the use of antibiotics to prevent and treat infection in newborn babies from birth to 28 days in both primary and secondary care. This standard includes antibiotics given to newborn babies, or mothers, during intrapartum care in order to prevent neonatal infection (antibiotic prophylaxis).
 
This quality standard is expected to contribute to improvements in the following outcomes:
  • infant mortality
  • admissions and readmissions to neonatal care units
  • maternity and neonatal length of hospital stay
  • neonatal neurological and auditory development
Date of Publication: December 2014
Endorsed on: May 2015
 
Full quality standard (PDF, 236KB, 43 Pages)
 

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)
 
Full Guideline (PDF, 172KB, 39 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE QS)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia.

Date of Publication: June 2012
Date of Endorsement: July 2012

Full quality standard (PDF, 257KB, 50 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE CG)

The guideline covers the diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people under 16 years in primary and secondary care.

The guideline is accompanied by a quick reference guide, parent/carer version, audit tools and algorithms.

RCPCH notes:

Please note that since publication of the guideline:

'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'

To:

'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'

  • NICE have updated the quick reference guide to reflect the action required when meningococcal meningitis is confirmed in children older than 3 months. Please see the NICE website for further information.
  • Recommendation 1.4.45 has been amended from:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'

    To:

    'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 5.75MB, 275 Pages)
NICE Guideline (Revised) (PDF, 294KB, 45 Pages)
Press Release (PDF, 47KB, 6 Pages)
 

Bronchiolitis in children (NICE)

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. It usually presents with cough with increased work of breathing, and it often affects a child's ability to feed. In primary care, the condition may often be confused with a common cold, though the presence of lower respiratory tract signs (wheeze and/or crackles on auscultation) in an infant in mid‑winter would be consistent with this clinical diagnosis. The symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness.

The guideline covers children with bronchiolitis but not those with other respiratory conditions, such as recurrent viral induced wheeze or asthma.
 
Date of Publication: May 2015
Endorsed on: June 2015
 
Full clinical guideline (PDF, 148KB, 29 Pages)
 

Constipation in Children and Young People (NICE)

This guideline covers the diagnosis and management of idiopathic constipation in children up to 18 years of age in primary and secondary care.

The guideline is accompanied by a quick reference guide, audit support, a baseline assessment tool, slide set and parent/carer version.

RCPCH notes:

The RCPCH welcomes publication of this guideline but asks Members to note:

  • Although not explicit in the NICE guideline, the College thinks that the goals of treatment should include 'no pain' and 'no overflow.
  • The guideline recommends some dosages which vary from those recommended in the British National Formulary for Children (2009 Edition). These are highlighted in the guideline. Please note that the BNF-c has been updated since publication of the guideline in 2010.

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF, 2.55MB, 255 Pages)
 

Diarrhoea and Vomiting In Children Under 5 (NICE)

This guideline covers the management of young children under 5 years of age with acute diarrhoea, with or without vomiting, due to gastroenteritis.

The guideline is accompanied by a quick reference guide, a parent/carer advice sheet to support consultations, costing tools, a slide set, audit support, and a chart to facilitate assessment of dehydration. It also includes key priorities for implementation.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline recommends that IV fluids should only be given if the child is in shock or is deteriorating despite ORS. It should be noted that NICE state that this recommendation has been made to prevent unnecessary IVT.
  • This guideline supersedes the Paediatric A&E Research Group guideline 'Children Presenting to Hospital with Diarrhoea, with or without Vomiting' published in 2002.

Date of Publication: April 2009
Date of Endorsement: August 2009

Full guideline (PDF, 3.18MB, 200 Pages)
NICE guideline (PDF, 1.82MB, 33 Pages)
Key Messages Presentation (PDF, 245KB, 21Pages)
 

Feverish Illness in Children (NICE QS)

This quality standard the assessment and initial management of unexplained feverish illness in infants and children (from birth to 5 years).
 
Feverish illness is very common in young children (under 5), with between 20 and 40% of parents reporting such an illness each year. Fever is the most likely reason for a child to be taken to the doctor and the second most common reason for a child being admitted to hospital.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • Mortality in infants and children under 5 years
  • Morbidity in infants and children under 5 years
  • Number of emergency admissions to hospital of infants and children under 5 years
  • Parent and carer experience of services.
Date of Publication: July 2014
Endorsed on: February 2015
 
Full quality standard (PDF, 196KB, 32 Pages)
 

Good Practice in Postoperative and Procedural Pain Management (APA)

 It is intended that this guideline will be used by practitioners involved in the acute care of children undergoing pain management after surgery or for painful medical procedures. The guideline is designed to provide evidence-based information on the efficacy of analgesic strategies such that an informed choice of analgesics that are appropriate for the patient and clinical setting can be made. The document includes advice on the assessment of pain and a summary of current evidence for the efficacy of analgesic strategies, including evidence-based recommendations which have been graded using the SIGN criteria and grouped according to named procedures. It is an update of the guideline published in 2008.

Date of Publication: July 2012
Date of Endorsement: July 2012

Full guideline (PDF, 731KB, 81 Pages)
 

Fractures (complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected complex facture. 
 
Two of the five guidelines in the NICE Trauma Suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It aims to reduce deaths and long-term health problems by improving the quality of emergency and urgent care.
 
The key clinical issues that are covered are as follows:
  • Initial triage by pre-hospital care provider
  • Initial assessment and management by pre-hospital care provider
  • Acute stage clinical assessment
  • Acute stage imaging assessment
  • Timing of referral and criteria for acceptance
  • Initial management and treatment plan
  • Ongoing management
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with complex fracture
  • Information and support needs of patients and their families and carers where appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,191KB, 278 Pages) 
NICE Clinical Guideline (PDF, 117KB, 18 Pages)
 

Fractures (non-complex): assessment and management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected non-complex facture. 
 
Two of the five guidelines in the NICE trauma suite relate to fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.
 
This guideline covers assessing and managing non-complex fractures that can be treated in the emergency department or orthopaedic clinic. It aims to improve practice so that people with fractures receive the care that they need without unnecessary tests and treatments.
 
The key clinical issues that are covered are as follows:
  • Assessment tools for initial triage
  • Acute-stage imaging assessment
  • Initial management and treatment plan
  • Ongoing management
  • Follow-up clinics
  • Skills to be present within the multidisciplinary team
  • Documentation of clinical assessments and management for people with fractures
  • Information and support needs of patients and their families and carers when appropriate.
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,577KB, 295 Pages) 
NICE Clinical Guideline (PDF, 111KB, 16 Pages)
 

Major trauma: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a suspected major traumatic injury. 
 
This guideline covers the rapid identification and early management of major trauma in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by improving the quality of their immediate care. It does not cover care for people with burns.
 
The key clinical areas covered are as follows:
  • Airway management
  • Pre-hospital management of chest trauma
  • Hospital management of chest trauma
  • Management of haemorrhage
  • Management of shock
  • Heat loss
  • Pain management
  • Documentation and transfer of information
  • Information and support
  • Skills to be present in the multidisciplinary team. 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,829KB, 330 Pages) 
NICE Clinical Guideline (PDF, 127KB, 21 Pages)
 

Major trauma: service delivery (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with a major traumatic injury or a suspected major traumatic injury. 
 
This guideline covers the organisation and provision of major trauma services in pre-hospital and hospital settings, including ambulance services, emergency departments, major trauma centres and trauma units. It aims to reduce deaths and disabilities in people with serious injuries by providing a systematic approach to the delivery of major trauma care. It does not cover services for people with burns.
 
The key service areas are:
  • Access to services
  • Appropriate destination
  • Continuity of care
  • Documentation and transfer of information
  • Audit
  • Provision of information
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 2,361KB, 203 Pages) 
NICE Clinical Guideline (PDF, 147KB, 20 Pages)
 

Management of Invasive Meningococcal Disease in Children and Young People (SIGN)

This guideline covers best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age.

The guideline is accompanied by a quick reference guide and information for parents and carers and includes key audit criteria.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The recommendation that "parenteral antibiotics (either benzylpenicillin or cefotaximine) should be administered in children as soon as IMD is suspected and not delayed pending investigations" is a Grade D recommendation and based upon expert opinion. Evidence from a systematic review by Hahne et al suggested that the use of parenteral antibiotics is inconsistent and that results are inconclusive. SIGN have amended the guideline to include this reference; however, the grading has not been altered as the recommendation is in line with advice from the Health Protection Agency.

Date of Publication: May 2008
Date of Endorsement: April 2009

Full guideline (PDF, 572KB, 53 Pages)
Quick reference guide (PDF, 181KB, 2 Pages)
Key messages (PDF, 537KB, 25 Pages)
 

Management of the Child with a Decreased Conscious Level (PAERG)

The scope of the guideline includes children aged 0-18 years who have a decreased conscious level and are being reviewed in a hospital setting. Decreased conscious level is defined as a modified Glasgow coma score less than 14, or being unresponsive only to voice or being unresponsive on the AVPU scale. The guideline does not apply to pre-term infants on a NICU or full term infants with a decreased conscious level from birth onwards. Also, the guideline does not apply to children with a previously diagnosed condition that is known to cause the decreased conscious level.

The guideline is accompanied by a quick reference algorithm, guide to implementation and audit criteria.

Date of Publication: November 2005
Date of Endorsement: October 2006

Full technical document (PDF, 594KB, 88 Pages)
Recommendations summary (PDF, 442KB, 59 Pages)
 

Organ Donation for Transplantation (NICE)

This guideline recognises the complexities that arise owing to the majority of potential adult and paediatric organ donors lacking the capacity to be directly involved in decision making at the time of their death. It covers strategies for improving donor identification and consent rates for deceased organ donation.

RCPCH notes:

The College asks members to note that:

  • There are few data on the validity of trigger tools in paediatric practice. NICE’s response to this comment is as follows: ‘The GDG made their decisions using the best available evidence, and where this was not available or lacking, the GDG based their recommendations on their clinical experience.’ It should be noted that NICE has deemed the best evidence from studies investigating conversion of patients displaying clinical triggers into organ donors is of very low quality.
  • Explicit reference to contraindications to donation from a paediatric perspective is not covered by the guideline.  This is because the GDG agreed that contraindications should not be included due to the rapid pace at which changes to contraindications occur particularly in paediatric patients.

Date of Publication: December 2011
Date of Endorsement: February 2012

Full guideline (PDF, 168KB, 28 pages)
Appendices
 

Paediatrics Allergy Action Care Plans (BSAC)

The plans have been designed to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training or equipment apart from access to an adrenaline auto injector (AAI). They may also be used to provide a framework for management of anaphylactic reactions to health professionals who are less familiar with this aspect of clinical care.

Date of Publication: September 2013
Date of Endorsement: October 2013

Personal plan for individuals prescribed EpiPen (PDF, 324KB, 1 Page)
A generic plans for individuals assessed as not needing AAI (PDF, 188KB, 1 Page)
Personal plans for individuals prescribed Jext (PDF, 188KB, 1 Page)
 

Physical Signs of Child Sexual Abuse (RCPCH)

This handbook is a revision of the 1997 RCP publication 'Physical Signs of Sexual Abuse in Children' and is based on the best available evidence. The review focuses on evidence for the physical signs of CSA in the following areas: female genitalia, male genitalia, anal signs, oral signs and sexually transmitted infections.

This was developed with The Royal College of Physicians of London and its Faculty of Forensic and Legal Medicine.

Date of Publication: April 2008
Date of Endorsement: April 2008

Further information can be found here
 

Post-Seizure Management (PAERG)

The guideline covers the management of children presenting following afebrile or febrile seizures based on the best available evidence. It aims to promote consistency of care of patients with similar clinical problems and helps clinicians recognise those children at higher risk of meningitis and to take appropriate action and to determine the cause of the fever if febrile seizure is diagnosed.

The guideline is accompanied by an algorithm for use in clinical areas.

RCPCH notes: 

This guideline is due for review by the Paediatric Accident and Emergency Research Group.

Date of Publication: July 2002
Date of Endorsement: December 2002

Full guideline (PDF, 275KB, 123 Pages)
 

Recognition and Assessment of Acute Pain in Children (RCN)

This guideline updates the Royal College of Nursing (RCN) guideline 'Assessment of Acute Pain in Children' (2001). The guideline covers the recognition of acute pain in children, as well as the assessment of acute pain using scales and other tools in children with and without cognitive impairment. It provides recommendations based upon the best available evidence.

The guideline is accompanied by a quick reference guide and poster, and includes implementation advice.

The RCPCH believes that the update of this guideline is extremely valuable. However, the College believes that it would be worthwhile to consider cross-cultural and ethnicity issues in a future update of the guideline.

Date of Publication: September 2009
Date of Endorsement: July 2009

Full guideline (PDF, 3.06MB, 74 Pages)
 

Respiratory Tract Infections (NICE)

This guideline covers the treatment of adults and children, 3 months or older, with respiratory tract infections (RTIs) for which immediate antibiotic prescribing is not indicated.

The guideline is accompanied by a quick reference guide, information for patients, slides highlighting the key messages and audit tools and includes care pathways, audit criteria and key priorities for implementation.

Date of Publication: July 2008
Date of Endorsement: January 2009

Full guideline (PDF, 629KB, 121 Pages)
Key Messages (PDF, 28.1KB, 20 Pages)
 

Sedation in Children and Young People (NICE)

This guideline covers the sedation of infants, children and young people up to the age of 19 years for diagnostic and therapeutic procedures.

The guideline is accompanied by a quick reference guide, audit support, a costing report, a baseline assessment tool and a slide set.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline recommends that referral to a mental health specialist should be considered for all children who are severely anxious or who have a learning disability undergoing an elective procedure. The College notes that this may significantly increase the waiting times for procedures, given the existing pressures upon mental health services.

Date of Publication: November 2010
Date of Endorsement: January 2011

NICE guideline (PDF, 219KB, 37 Pages)
 

Self-Harm: Longer-Term Management (NICE)

This guideline is concerned with the longer-term psychological treatment and management of both single and recurrent episodes of self-harm. It does not cover recommendations for the physical treatment of self-harm or for psychosocial management in emergency departments (these can be found in NICE clinical guideline 16 which covers treatment of self-harm within 48 hours of an incident). The term self-harm used in this guideline refers to any act of self-poisoning or self-injury.

Date of Publication: November 2011
Date of Endorsement: February 2012

NICE guideline (PDF, 212KB, 40 Pages)
Appendices
 

Self-Harm: Short-Term Physical and Psychological Management and Secondary Prevention (NICE)

This guideline covers the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. It covers all children aged 8 years and older, young people and adults who have carried out self-harm, regardless of whether accompanied by mental illness. The guideline makes recommendations that cover the first 48 hours following an act of self-harm but does not address long-term psychiatric care.

The guideline is accompanied by key recommendations for implementation.

Date of Publication: July 2004
Date of Endorsement: February 2005

NICE guideline (PDF, 121KB, 49 Pages)
 

Spinal injury: assessment and initial management (NICE)

NICE were asked by the Department of Health to develop a suite of clinical guidelines related to the management of people with traumatic injuries. Topics covered include:
  • Complex fractures
  • Fractures (non-complex)
  • Major trauma
  • Service delivery of trauma services
  • Spinal injury assessment
These guidelines are related topics with overlap in populations and key clinical areas for review. However, each guideline ‘stands alone’ and addresses a specific area of care. 
 
This clinical guideline covers adults, young people and children who present with suspected spinal column or spinal cord injury secondary to a traumatic event. 
 
This guideline covers the assessment and early management of spinal column and spinal cord injury in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. It covers traumatic injuries to the spine but does not cover spinal injury caused by a disease.It aims to reduce death and disability by improving the quality of emergency and urgent care.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 3,363KB, 247 Pages) 
NICE Clinical Guideline (PDF, 120KB, 22 Pages)
 

The management of children and young people with an acute decrease in conscious level (RCPCH)

This guideline aims to give clinicians working acutely a framework to aid the timely and safe care of children and young people (aged four weeks to 18 years) presenting with a decreased conscious level of unknown cause.
 
The first guideline for 'The Management of Decreased Conscious Level' was published in 2005. Since, there have been changes in the demographics of the children and young people presenting to emergency settings with a decreased conscious level. 
 
Consistent with the previous guideline, this version emphasises the importance of managing this condition in a standard manner from first presentation to health services, to ensure the best outcome for patients and their families.
 
The continuing support of the National Reye's Syndrome Foundation UK (NRSF-UK) has allowed the work required to update the guideline.
 
Date of Publication: April 2015
Date of Endorsement: February 2015
 

Urinary Tract Infection in Children (NICE)

The guideline covers the investigations and treatment for children younger than 16 years who have a urinary tract infection (UTI) and the information that should be offered to their families. Urine testing strategies are provided. The guideline is particularly relevant to all healthcare professionals who are involved in providing care for children who have a UTI, those responsible for commissioning and planning healthcare services and children who have a UTI and their families.

The guideline includes key priorities for implementation, a quick reference guide, information for parents/carers, slides highlighting the key messages, audit criteria, costing tools, implementation advice, and an online educational tool.

Date of Publication: August 2007
Date of Endorsement: March 2008

Full guideline (PDF, 5.56MB, 178 Pages)
NICE guideline (PDF, 252KB, 30 Pages)
 

Urinary Tract Infection in Febrile Infants and Young Children (AAP)

The aim of the guideline was to formulate recommendations for health care professionals about the diagnosis, treatment, and evaluation of an initial urinary tract infection (UTI) in febrile infants and young children ages 2 months to 2 years.

The guideline includes an algorithm.

RCPCH notes: 

This guideline will be updated in 2009 by the American Academy of Pediatrics.

Date of Publication: April 1999
Date of Endorsement: April 1999

Technical report (PDF, 990KB, 60 Pages)
 

When to Suspect Child Maltreatment (NICE)

This guidance covers the clinical features (including physical and psychological symptoms) associated with maltreatment which may be observed by health professionals when a child presents to them. It is aimed at all health professionals, including GPs, primary health and child health teams, professionals groups who are routinely involved in the care of children and families and those who may encounter children in the course of their professional duties.

The guideline is accompanied by a quick reference guide, costing tools, slides highlighting the key messages, audit support tools and an educational tool.

The RCPCH welcomes the publication of this valuable and important guidance and fully endorses it. The College notes that:

  • The NICE guideline uses less technical terms which in some areas may appear to differ from RCPCH documents. This is because the intended audience of the NICE guideline is front line health professionals rather than specialist paediatricians (although the guideline is of relevance to paediatricians also).

Please note: As of December 2009, recommendation 5.8 on inappropriately explained school attendance has been amended. This recommendation has been changed from:

"Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and formally approved home education is not being provided."

to:

"Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and home education is not being provided."

Date of Publication: July 2009
Date of Endorsement: July 2009

Full guideline (PDF, 1.48MB, 156 Pages)
NICE guideline (PDF, 372KB, 39 Pages)
Key messages (PDF, 235KB, 12 Pages)
RCPCH press statement (PDF, 37KB, 1 Page)
 

Supported guidelines

Late intrauterine fetal death and stillbirth (RCOG)

This guideline identifies evidence-based options for women (and their relatives) who have a late intrauterine fetal death (IUFD: after 24 completed weeks of pregnancy) of a singleton fetus. It includes information on general care before, during and after birth, and care in future pregnancies.

Date of publication: October 2010
Date of College support: 2011

Full guideline (PDF, 460KB, 33 Pages)
 

Surgical Site Infection (NICE)

This guideline covers the prevention and treatment of surgical site infection in adults and children undergoing surgical incisions through the skin, including minimal invasive surgery.
 
The guideline is accompanied by a costing report, slide set, quick reference guide, parent/carer version and audit support and includes audit criteria.
 
Date of publication: October 2008
Date affirmed: September 2009
 
Full guideline (PDF, 5.9 MB, 168 Pages)
NICE guideline (PDF, 213 KB, 28 Pages)
 
RCPCH Comments:
The RCPCH welcomes the publication of this guideline but asks Members to note the following:
  • The guideline presents recommendations relating to the prevention and treatment of surgical site infection, however the Guideline Development Group did not include paediatric representation