Urgent referrals

Red flag conditions - 'same day' urgency 

• Bone or joint pain or back pain and presence of red flags (fever, systemic upset, night pain, weight loss, pallor, bruising).
• Non-weight bearing / acute limp.
• Painful scoliosis. 
• Concerns about non-accidental injury.

New patients with suspected inflammatory joint or muscle or multi-system disease warrant urgent referral (within a week) and discussion with paediatric rheumatology 

• Swollen or stiff joints, muscle pain or weakness. 
• Multisystem disease (rash suggestive of vasculitis, Raynaud's, uveitis, fever).

Patients with known inflammatory disease or multisystem disease who have symptoms of flare will need to contact the paediatric rheumatology team and often patients will have contact details and know when to seek further advice.

Immunosuppressed Patients (due to treatment or the underlying condition) can become unwell quickly and may not show typical features of infection.

• Treatments include, for example, corticosteroids, methotrexate or biological therapies.
• Common childhood infections, such as chicken pox can be much more serious.
• Recognising the Sick Child is critical