If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.

It is proposed that the following conditions should be sent directly to emergency. This is not a list of all conditions that should be sent to the emergency department, it is intended as guidance for presentations that may otherwise have been directed to general paediatric outpatients:

Brain and Nervous System

• Headaches
  • that wake at night or headaches immediately on wakening
  • new and severe headaches
  • associated with significant persisting change of personality or cognitive ability or deterioration in school performance
  • recent head injury or head trauma
  • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
  • sudden onset headache reaching maximum intensity within 5 minutes ( = explosive onset)
  • presence of an intracranial CSF shunt
  • hypertension above 95th centile by age for systolic or diastolic
• Seizures
  • all children with new onset of clinically obvious epileptic seizures should be referred to emergency for initial assessment, observation and consideration of emergency investigation or management.
  • any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia
  • significant change in seizures for established epilepsy:
    • new onset of focal seizures or
    • a dramatic change in seizure frequency or duration
• Faints syncope and funny turns
  • loss of consciousness in association with palpitations
  • sudden loss of consciousness during exercise
  • possible infantile spasms. this may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old

Respiratory

• Asthma, stridor and wheeze
  • infants who have apnoea or cyanosis during paroxysms of coughing
  • children with recurrent or persistent respiratory symptoms who have had an episode of choking
  • suggestive a possible inhaled foreign body
  • recent onset or escalating stridor and respiratory distress
  • acute respiratory distress not responding to home management
  • acute respiratory symptoms causing inability to feed or sleep in an infant
• Persistent and chronic cough
  • infants who have apnoea or cyanosis during paroxysms of coughing
  • children with recurrent or persistent respiratory symptoms who have had an episode of choking suggestive a possible inhaled foreign body
  • prominent dyspnoea, especially at rest or at night
  • cough causing inability to feed or sleep in an infant

Gastroenterology

• Chronic & Recurrent Abdominal Pain
  • severe pain not able to managed at home with simple analgesia
  • significant change in location or intensity of chronic abdominal pain suggestive of a new pathology
  • pain associated with vomiting where this has not occurred before
  • bile stained vomiting
• Chronic Diarrhoea and/or Vomiting
  • vomiting or diarrhoea with weight loss in an infant <1 year
  • suspected pyloric stenosis
  • bile stained vomiting
  • acute onset abdominal distention
  • weight loss with cardiovascular instability, e.g. postural heart rate changes
  • new onset of blood in diarrhoea or vomitus
• Constipation with or without soiling
  • severe abdominal pain or vomiting with pain

Urinary

• Urinary Incontinence and enuresis.
  • recent onset of polyuria/polydipsia that might suggest diabetes (mellitus or insipidus)
• Recurrent Urinary Tract Infections (UTI)
  • acute infant urinary tract infection presenting septicaemia or acutely unwell

Musculoskeletal

• Acute joint pain with fever
• Acute joint pain unable to weight bear.

Cardiac

• Infant <3 months with newly noted murmur and any of the following:
  • poor feeding
  • slow weight gain
  • weak or absent femoral pulses
  • post ductal (foot) oxygen saturation < 95%
  • respiratory signs (wheeze, recession or tachypnea)

Allergies

• Anaphylaxis
• Allergic reaction where there are any respiratory or cardiovascular symptoms or signs
• Reaction to peanut or other nut should be referred to Emergency as these reactions can progress rapidly and should be observed and assessed in Emergency
• Exposure to a known allergen with a previously identified potential for anaphylaxis in this patient even if the reaction appears currently mild
• Severe angioedema of face

Growth concerns

• Faltering growth (failure to thrive in children < 6 years
  • severe malnutrition
  • temperature instability
  • cardiovascular instability – postural heart rate change
• Short stature
  • possible CNS signs (visual disturbance, morning headaches)

Developmental concerns

• Non verbal child with acute distress and unable to examine adequately for medical conditions causing pain eg tooth abscess, bone infections or osteopaenic fractures

Behavioural concerns

• Suicidal or immediate danger of self-harm
• Aggressive behaviour with immediate threatening risk to vulnerable family members

Irritable Infant

• Fluctuating or altered conscious level – weak cry, not waking appropriately for feeds, lethargy, maternal concern of failure of normal interaction
• Suspicion of harm or any unexplained bruising, especially in infant <3 months
• Significant escalation in frequency or volume of vomiting
• New onset of blood mixed in stool
• Fever
• Increased respiratory effort
• Weak or absent femoral pulses in infant <3 months
• Presence of newly noted heart murmur in infant <3 months

Physical findings of concern in an infant <1 year

• Inguinal hernia that cannot be reduced.
• Painless firm neck swelling that is increasing in size.
• White pupil or white instead of red reflex on eye examination.
• Previously unrecognised intersex genitals (ambiguous as either virilised female or incomplete formation male eg bilateral absent testes).
• Possible Infantile Spasms. This may be frequent brief episodes of head bobbing (with or without arm extension) in an infant less than 12 months old.
• Absent femoral pulses.
• Infant <3 months with newly noted murmur and any of the following:
  • poor feeding
  • slow weight gain
  • weak or absent femoral pulses
  • post ductal (foot) oxygen saturation < 95%
  • respiratory signs (wheeze, recession or tachypnea)

Diabetes

• New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
• Ketoacidosis in a known diabetic with any of the following:
  • systemic symptoms (fever, lethargy)
  • vomiting
  • inability to eat (even if not vomiting)
  • abdominal pain
  • headache

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services

 Does your patient meet the minimum referral criteria?

If your patient does not meet the minimum referral criteria

• Consider other treatment pathways or an alternative diagnosis
• If you still need to refer your patient:
  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Patient's Demographic Details

• Full name (including aliases)
• Date and country of birth
• Residential and postal address including whether patient resides at an aged care facility
• Telephone contact number/s – home, mobile and alternative
• Medicare number (where eligible)
• Name of the parent or caregiver (if appropriate)
• Name of delegate and contact details (Department of Corrective Services)
• Preferred language and interpreter requirements
• Identifies as Aboriginal and/or Torres Strait Islander
• Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

• Full name
• Full address
• Contact details – telephone, fax, email
• Provider number
• Date of referral
• Signature
• Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

• Presenting symptoms (evolution and duration)
• Physical findings
• Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
• All conservative options that have been pursued unsuccessfully prior to referral
• Body mass index (BMI)
• Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
• Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
• Current medications and dosages
• Drug allergies
• Alcohol, tobacco and other drugs use

Reason for request

• To establish a diagnosis
• For treatment or intervention
• For advice and management
• For specialist to take over management
• Reassurance for GP/second opinion
• For a specified test/investigation the GP can't order, or the patient can't afford or access
• Reassurance for the patient/family
• For other reason (e.g. rapidly accelerating disease progression)
• Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

• Impact on employment
• Impact on education
• Impact on home
• Impact on activities of daily living functioning – low/medium/high
• Impact on ability to care for others
• Impact on personal frailty or safety
• Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery (where surgery is a likely intervention)
• Choice to be treated as a public or private patient
• Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)