Association between the presence of alarm features and referral by the GP
| Alarm features according to national guidance | NICE traffic light system10 | Positive LR >5 in systematic review12 | Referred (n = 794; n [%]) | Non-referred (n = 9000; n [%]) | Univariate ORa OR (95% CI) | Adjusted ORb,c OR (95% CI) | |
|---|---|---|---|---|---|---|---|
| Age <1 month | Yes | Red | No | 25 (3.1) | 7 (0.1) | 42 (18 to 97) | 64 (26 to 161) |
| Age 1–3 months | Yes | Red | No | 74 (9.3) | 98 (1.1) | 9.4 (6.8 to 13) | 11 (7.8 to 17) |
| Ill appearance | Present | Red | Yes | 255 (32) | 463 (5.1) | 8.7 (7.3 to 10) | 6.8 (5.4 to 8.6) |
| Decreased consciousness | Present | Red | Yes | 53 (6.7) | 4 (<0.1) | 161 (58 to 446) | 134 (45 to 399) |
| Abnormal circulation | Present | Red | Yes | 71 (25) | 91 (4) | 8.1 (5.7 to 11) | 3.9 (2.4 to 6.4) |
| Persistent vomiting | Present | Red (if bile-stained) | No | 231 (29) | 1842 (21) | 1.6 (1.4 to 1.9) | 1.3 (1.1 to 1.7) |
| Petechial rash | Present | Red | Yes | 15 (1.9) | 19 (0.2) | 9.1 (4.6 to 18) | 12 (5.3 to 28) |
| Meningeal irritation | Present | Red | Yes | 49 (6.2) | 6 (0.1) | 99 (42 to 231) | 90 (36 to 229) |
| Severe shortness of breath | Present | Amber/red | Yes | 213 (27) | 270 (3.0) | 12 (9.7 to 15) | 12 (8.9 to 15) |
| Signs of dehydration (all ages) | Present | Amber/red | No | 78 (9.8) | 18 (0.2) | 54 (32 to 91) | 41 (22 to 77) |
↵a Univariate analyses was performed on complete case analyses for ‘abnormal circulation’ (Ntot = 2586); ‘signs of UTI’ (Ntot = 3966); ‘temperature ≥40°C’ (Ntot = 8555) and ‘duration of fever’, truncated at the 97.5th percentile (= 7 days; Ntot = 8071).
↵b Multivariate analyses was performed on the multiple (10x) imputed dataset (Ntot = 9794).
↵c Nagelkerke’s R2 (median) = 0.40. LR = likelihood ratio. OR = odds ratio