P NG254

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Good question. The risk‑thresholds in NICE NG254 (under‑16s) are stratified by age group (under 5, 5–11, 12–15) and by clinical/laboratory criteria. Here’s a breakdown of the main thresholds:

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🔍 Risk thresholds by age group

Under 5 years

From the NG254 evaluating‑risk chart: (NICE)

• High risk if any of:

  • Behaviour: no response to social cues, appears ill, doesn’t wake, or weak/high-pitched/continuous cry (NICE)

  • Skin: mottled/ashen, cyanosis, non‑blanching rash (NICE)

• Moderate-to-high risk if:

  • Behaviour: not responding normally to social cues, no smile, wakes only with stimulation, decreased activity, parental concern about behaviour change (NICE)

  • Circulation/hydration: capillary refill ≥ 3 s, reduced urine output (< 1 ml/kg/hour in catheterised) (NICE)

  • Skin: pallor, cold hands/feet, leg pain (NICE)

• Low risk: if none of the high or moderate-to-high criteria are met. (NICE)

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Age 5–11 years

From NG254 risk‑stratification tool for 5‑11s: (NICE)

Some key thresholds:

Parameter	High risk	Moderate-to-high risk
Heart rate (bpm)

• Age 5: ≥ 130 (NICE)

• Age 6–7: ≥ 120 (NICE)

• Age 8–11: ≥ 115 (NICE) |

• Age 5: 120–129 (NICE)

• Age 6–7: 110–119 (NICE)

• Age 8–11: 105–114 (NICE) |
  | Respiratory rate (breaths/min) |

• Age 5: ≥ 29 (NICE)

• Age 6–7: ≥ 27 (NICE)

• Age 8–11: ≥ 25 (NICE) |

• Age 5: 24–28 (NICE)

• Age 6–7: 24–26 (NICE)

• Age 8–11: 22–24 (NICE) |
  | Oxygen saturation | < 90% in air or increased O₂ requirement (NICE) | < 92% in air or increased O₂ requirement (NICE) |
  | Behaviour | Objective altered mental state, appears ill, not waking/responding appropriately (NICE) | Not behaving normally, decreased activity, carer concern (NICE) |
  | Circulation / Hydration | Heart rate / cap refill / urine output criteria (e.g. cap refill ≥ 3s, reduced urine) (BEST) | Same plus other moderate signs like reduced urine or cap refill delay (NICE) |
  | Skin / Other signs | Mottled / ashen skin, cyanosis, non-blanching rash (BEST) | Cap refill ≥ 3s, cold hands/feet, leg pain (BEST) |
  | Temperature | Tympanic temp < 36°C (NICE) | (Same criterion for moderate-to-high) (NICE) |

• Low risk: no high or moderate-to-high criteria met. (NICE)

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Aged 12–15 years

Based on NG254 (and prior NG51) criteria: (NCBI)

Some thresholds:

• High risk: new altered mental state, raised respiratory rate (≥ 25 breaths/min), new need for oxygen (≥ 40% FiO₂ to keep saturation > 92%) (NICE)

• Moderate-to-high risk: respiratory rate 21–24 breaths/min (NICE)

• Blood pressure:

  • High risk: systolic ≤ 90 mmHg or > 40 mmHg below normal (NICE)

  • Moderate-to-high: systolic 91–100 mmHg (NICE)

• Circulation / Hydration:

  • High risk: heart rate > 130 bpm, not passed urine in 18 h (or < 0.5 ml/kg/hr if catheter) (NICE)

  • Moderate-to-high: heart rate 91–130 bpm (or 100–130 in pregnancy), reduced urine even if catheterised (0.5–1 ml/kg/hr) (NICE)

• Temperature: moderate-to-high risk if tympanic temp < 36°C (NICE)

• Skin: high risk if mottled/ashen, cyanosis, non‑blanching rash (NICE)

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General principle

• High risk: if any high-risk criterion is met → escalate urgently. (NICE)

• Moderate-to-high risk: if 2 or more moderate-to-high risk criteria (in hospital settings) or at least 1 (in some contexts) → close monitoring and further investigation. (NICE)

• Low risk: if neither high nor moderate-to-high criteria are present → safety‑netting, give advice on symptoms, monitor. (NICE)

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If you like, I can send a table of all the risk‑thresholds (for all age‑bands) from NG254 (or a screenshot summary). Do you want me to do that?