Article Figures & Data
Figures
- Figure 1.
Flow chart of children included in analysis.15
- Figure 2.
Bar chart demonstrating the traffic light categories for children admitted and not admitted to hospital, and those with a serious illness. These figures have been rounded to the nearest five to comply with the ‘small data’ reporting requirements of the Secure Anonymised Information Linkage (SAIL) databank.
Tables
How this fits in
The National Institute for Health and Care Excellence (NICE) traffic light system is widely used in general practice for the assessment of unwell children; however, the majority of previous studies validating this tool have been conducted in secondary care settings. To that authors’ knowledge, no studies have validated this tool within UK general practice. This study found that the traffic light system cannot accurately detect or exclude serious illness in children presenting to UK general practice with an acute illness. The conclusion reached was that it cannot be relied on by clinicians for the assessment of acutely unwell children and that it is unsuitable for use as a clinical decision tool. - Table 1.
Characteristics of the DUTY children presenting to general practice by hospital admission status within 7 days
Characteristic DUTY cohort (n = 6703) DUTY children not admitted to hospital (n= 6564)a DUTY children admitted to hospital (n = 139)a Age at recruitment, months, n (%) <3 198 (3.0) 191 (2.9) 7 (5.0) 3–5 409 (6.1) 395 (6.0) 14 (10.1) 6–11 1065 (15.9) 1041 (15.9) 24 (17.3) 12–23 1577 (23.5) 1541 (23.5) 36 (25.9) 24–35 1263 (18.8) 1248 (19.0) 15 (10.8) 36–47 1257 (18.8) 1227 (18.7) 30 (21.6) ≥48 934 (13.9) 921 (14.0) 13 (9.4) Age, years, median (IQR) 2.1 (1.0–3.4) 2.1 (1.0–3.4) 1.6 (0.9–3.1) Sex, n (%) Male 3282 (49.0) 3213 (48.9) 69 (49.6) Female 3421 (51.0) 3351 (51.1) 70 (50.4) Traffic light category, n (%) Green 383 (5.7) 378 (5.8)b 5 (3.4)b Amber 4204 (62.7) 4154 (63.3)b 50 (34.5)b Red 2116 (31.6) 2026 (30.9)b 90 (62.1)b - Table 2.
Prognostic performance of the NICE traffic light system for detecting serious illness
Test performance for detecting children with a serious illness Sensitivity, % (95% CI) Specificity, % (95% CI) Positive predictive value, % Negative predictive value, % Red category only 58.8 (32.9 to 81.6) 68.5 (67.4 to 69.6) 0.5 99.8 Red or amber category 100 (80.5 to 100) 5.7 (5.2 to 6.3) 0.3 100 NICE = National Institute for Health and Care Excellence.
- Table 3.
Prognostic performance of the NICE traffic light system for detecting hospital admission
Test performance for detecting children admitted to hospital Sensitivity, % (95% CI) Specificity, % (95% CI) Positive predictive value, % Negative predictive value, % Red category only 61.9 (53.3 to 70.0) 69.1 (67.9 to 70.2) 4.1 98.8 Red or amber category 97.8 (93.8 to 99.6) 5.8 (5.2 to 6.4) 2.2 99.2 NICE = National Institute for Health and Care Excellence.
- Table 4.
Prognostic performance of the NICE traffic light system for detecting febrile children with a serious illness
Test performance for detecting serious illness in febrile children Sensitivity, % (95% CI) Specificity, % (95% CI) Positive predictive value, % Negative predictive value, % Red category only 62.5 (35.4 to 84.8) 64.0 (62.7 to 65.3) 0.6 99.8 Red or amber category 100 (79.4 to 100) 3.0 (2.5 to 3.5) 0.3 100 NICE = National Institute for Health and Care Excellence.
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