Any of the following criteria are to be met for admission in a hospital and in-hospital treatment:

Febrile Illness Clinical key pointers for Admission:

• Fever >= 38.3'C or >=101'F for more than 2 days
• Any Fever for more than 5 days – not responding to OP treatments – worsening symptoms
• Along with any or all of following: Headache, Dizziness, Pain in Muscles and Joints, Weakness
• Patients presenting with AFI and signs of organ dysfunction and symptoms/signs suggestive of sepsis, like
  • Grossly deranged Liver function tests, Renal Function tests,
  • Patches in lungs / ARDS
  • Deranged CNS – having: drowsiness of altered sensorium / hypotension or cardiac suppression / repeated vomiting or loose stools with signs of dehydration / not able take orally with signs of dehydration / oliguria)
• Other signs such as those mentioned below can also justify admission
  • Severe Hypotension -
  • Toxic look
  • Febrile Seizures
  • Petechial or purpuric rash
• Elderly patients more than 65 years of age with comorbid conditions
• Respiration: respiratory rate more than 22/min; cyanosis; arterial oxygen saturation less than 92% on room air
• Circulation – blood pressure – systolic less than 100mm Hg; capillary refill > 3 secs
• Very high WBC count(>12,000/cmm) – indicating septicaemia or sepsis
• Hemophagocytic Lymphohistiocytosis (HLH)

Ref:

• IMA guidelines
• Bhargava A, Ralph R, Chatterjee B, et al. Assessment and initial management of acute undifferentiated fever in tropical and subtropical regions. BMJ. 2018;363: k4766. Published 2018 Nov 29. DOI:10.1136/bmj. k4766

*Antibiotic use – As per the approved antibiotic policy of the hospital

Admission Criteria for Fever in Children

• Seizures, difficulty to stay awake, and stiff neck
• Toxic appearance, listlessness
• Lethargy 
• Irritability 
• Dehydration 
• Severe malnutrition 
• Toxic appearance 
• Inability to feed 
• A 14-day illness without a confirmed diagnosis 

Other Red Flags:

Additional signs that warrant immediate attention and potential hospital admission include:

• Bleeding: red spots or patches on the skin, bleeding from nose or gums, vomiting blood, black stools, heavy menstruation/vaginal bleeding  - Petechiae or purpura
• Frequent vomiting 
• Severe abdominal pain 
• Drowsiness, mental confusion, or seizures 
• Pale, cold, or clammy hands and feet 
• Difficulty breathing - Respiratory distress
• Signs of dehydration 
• Lethargy or unconsciousness 
• Sunken eyes 
• Slow skin pinch recoil 
• Red maculopapular rash: May be associated with conditions like measles, rubella, or dengue 
• Fine generalized maculopapular rash with systemic dysfunction/shock: Could be indicative of meningococcemia 

Ref –

• IMA guidelines
• Schellack N, Schellack, G. An overview of the management of fever and its possible complications in infants and toddlers. SA Pharm J. 2018. 85. 26–33

 Admission Criteria for Dengue fever:

• ADMISSION CRITERIA
  • Persistent vomiting
  • Dehydration
  • Abdominal tenderness
  • Hepatomegaly
  • Ascites
  • Oedema
  • Mucosal bleed

• blood in vomit or stool
• pale and cold skin

• Respiratory distress
• Pleural effusion
• Hypotension/shock - drop in Systolic BP of ≥20mmHg and diastolic of ≥10 mmHg indicates postural hypotension
• Oliguria
• Rising Haematocrit> 60%
• Drastic rapid decrease in platelets or any platelet count with bleeding symptoms
• Ascites/ pleural effusion / hypotension / polyserositis / dengue haemorrhagic fevers / dengue shock
• Dengue haemorrhagic fever – thrombocytopenia – mucosal and gastrointestinal bleeds – rise in haematocrit
• Dengue shock syndrome – weak pulse – hypotension
• Expanded dengue syndrome – encephalitis – myocarditis – hepatitis – renal failure – ARDS – haemophagocytosis
• Dengue Haemorrhagic Fever (DHF) with the following criteria:

• Metabolic acidosis/ hyperpnoea/ Kussmaul’s breathing
• Oliguria or anuria
• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥1000 units/L
• Impaired consciousness (GCS < 9)
• Febrile seizures in young children •
• Nervous System - Encephalopathy - Encephalitis/aseptic meningitis • Intracranial haemorrhages/thrombosis • Subdural effusions • Mononeuropathies/polyneuropathies/Guillane-Barre Syndrome • Transverse myelitis
• Gastrointestinal system : Hepatitis/fulminant hepatic failure • Acalculous cholecystitis • Acute pancreatitis • Hyperplasia of Peyer’s patches • Acute parotitis
• Kidney : Acute renal failure • Hemolytic uremic syndrome(HUS)
• Heart -Conduction abnormalities • Myocarditis • Pericarditis
• Lungs - Acute respiratory distress syndrome • Pulmonary haemorrhage
• Musculoskeletal system - Myositis with raised creatine phosphokinase (CPK) • Rhabdomyolysis Lymphoreticular system •
• Infection associated haemophagocytic syndrome - Haemophagocytic lymphohistiocytosis (HLH) • Idiopathic thrombocytopenic purura (ITP) • Spontaneous splenic rupture • Lymph node infarction
• Eye - Macular haemorrhage • Impaired visual acuity • Optic neuritis

• INDICATIONS FOR PLATELET TRANSFUSION
  • For adults: platelets < 40000 and with bleeding symptoms
  • Platelet count less than 10000.
  • Prolonged shock with coagulopathy ]
  • Systemic massive bleeding

Ref:

• IMA guidelines
• National Vector Control Board Guidelines( followed by AIIMS)/ Ministry of Family Health & Welfare - Guidelines – 2008 and 2023
• WHO guidelines
• The Indian Society of Critical Care Medicine Tropical Fever Group, Singhi S, Chaudhary D, et al. Tropical fevers: Management guidelines. Indian J Crit Care Med. 2014;18(2):62-69. DOI:10.4103/0972–5229.126074
• Guidelines for management of co-infection of COVID-19 with other seasonal epidemic prone diseases. Available at: https://www. mohfw.gov.in/pdf/GuidelinesformanagementofcoinfectionofCOVID19withotherseasonalepidemicpronediseases.pdf. Accessed on: 03 September 2021
• National Health Mission. Guidelines for management of dengue fever. Available at: https://www.nhm.gov.in/images/pdf/ guidelines/nrhm-guidelines/stg/dengue.pdf. Accessed on: 03 September 2021

Admission Criteria for Pneumonia in Children

• Important Signs
  • Cough , cold with or without Fever, that includes fast breathing and chest indrawing
  • Along with inability to drink or persistent vomiting or convulsions or lethargy/unconscious, Stridor or severe Malnutrition
  • Admission justified in severe pneumonia as per ICMR protocols

Ref:

https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952336_paediatrics_severe_pneumonia.pdf

Admission Criteria for Pneumonia in Adult

• Breathlessness, Pleuritic Chest pain, Malaise, arthralgia, Hemoptysis
• Criticality parameters – Respiratory Rate - >30/min, Abdominothoracic respiration, Cyanosis, Inability to speak long sentences
• ARDS
• Breathlessness at rest or on exertion
• Oxygen saturation less than 92%
• With COPD or Interstitial lung disease or any restrictive lung disease
• Admission – Score 1 to 4 are advised admission as per ICMR protocols

Ref:

https://www.icmr.gov.in/icmrobject/uploads/STWs/1725963734_pulmonology_acute_respiratory_infections.pdf

Admission Criteria in Diarrhea/Acute  Gastroenteritis

• >3 loose or watery stools per day or blood in stool (Dysentery)
• And any 2 of the following signs
  • Lethargy/Unconscious
  • Sunken eyes
  • Not able to Drink/Drinking poorly
  • Skin pinch – goes back slowly

Admission Criteria for Hepatitis / other Jaundice

• INR >1.5 or rising INR
• Altered sensorium
• Bleeding
• Recurrent vomiting with dehydration
• Hypotension (Systolic BP<90 mmHg)

Ref:

https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_diarrhea.pdf

Admission criteria for Acute Rhinosinusitis /URI

• Known Diabetic /Immunocompromised
• Suspicion of Complications like
  • Orbital involvement (Periorbital edema/Erythema, Displaced globe, Ophthalmoplegia, Visual Disturbances)
  • Meningitis/ Altered Sensorium
  • Frontal Fullness
• Non Resolution with Oral antibiotics for 7 days
• Pointers for invasive Fungal sinusitis (Facial Hypoesthesia, facial skin,/palatal/turbinate discoloration)

Ref:

Refer Pg8(https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952349_ent.pdf )

https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952349_ent_pharyngitis_and_sore_throat.pdf

• The participating hospitals are requested to take herewith the above guidelines for admission and basic treatment as a guidepost to decide upon admission and basic treatment for the commonly encountered fevers and infections as mentioned above – in exceptional cases the protocol may be decided by the treating Doctor as the case may be and depending on the clinical scenario and clinical features of the patient.
• Request that any deviation from the above published guidelines should be justified clinically and supported with any suitable nationally or internationally accepted published guidelines.