Table 1

Severity of circulatory impairment classifications

Clinical groupDefinition
SICChildren with severe febrile illness who have all four of the following features:

  • ▪ AVPU<A

  • ▪ Weak/absent peripheral pulse

  • ▪ Prolonged capillary refilling >3 s

  • ▪ Cold limb extremities (hands and feet) typically with cold skin extending up the limb (referred to as a temperature gradient)

These children typically also have secondary signs such as altered consciousness
ICChildren with severe febrile illness who may have AVPU<A, or prostration or respiratory distress plus at least ONE of the following features are included in this group:

  • ▪ Weak peripheral pulse

  • ▪ Capillary refilling >2 s

  • ▪ Cold limb extremities with a temperature gradient

  • ▪ Severe tachycardia (>180/min if aged 2–12 m, >160/min if aged 1–4 years)

IC but without SICBy exclusion a third clinical grouping can be defined, those withimpaired circulation but without severe impairment 

  • AVPU, Alert, responsive to Verbal, Painful stimuli, or Unresponsive; IC, impaired circulation; SIC, severely impaired circulation.