Abstract
Background: The NICE Traffic Light system was created to facilitate the assessment of unwell children in primary care. No studies have evaluated this tool in UK general practice. Aim: To evaluate the accuracy of this system for detecting serious illness in children presenting to general practice. Design and Setting: Retrospective diagnostic accuracy study, using a cohort of acutely unwell children under five years presenting to general practice in England and Wales. Method: The Traffic Light categories of 6,703 children were linked with hospital data to identify admissions and diagnoses. The sensitivity and specificity of these categories were calculated against the reference standard: a hospital diagnosed serious illness within seven days of GP consultation, measured using ICD-10 codes. Results: 2,116 (31·6%) children were categorised as red; 4,204 (62·7%) amber; and 383 (5·7%) green. 139 (2·1%) children were admitted to hospital within seven days of consultation, of whom 17 (12·2%; 0·3% overall) had a serious illness. The sensitivity of the ‘red’ category (vs. amber/green) was 58·8% (95% confidence interval: 32·9% to 81·6%) and the specificity 68·5% (67·4% to 69·6%). The sensitivity and specificity of ‘red’ and ‘amber’ combined (vs. green) was 100% (80·5% to 100%) and 5·7% (5·2% to 6·3%) respectively. Conclusion: The Traffic Light system cannot accurately detect children admitted with a serious illness, nor those not seriously ill who can be managed at home. This system is not suitable for use as a clinical tool in general practice. Further research is required to update or replace the Traffic Light system.
| Original language | English |
|---|---|
| Pages (from-to) | e398-e404 |
| Number of pages | 7 |
| Journal | British Journal of General Practice Open |
| Volume | 72 |
| Issue number | 719 |
| Early online date | 24 Mar 2022 |
| DOIs | |
| Publication status | Published - 17 May 2022 |
Bibliographical note
Funding Information:Many thanks to all those involved in the DUTY study. This study makes use of the Secure Anonymised Information Linkage databank. The authors would like to acknowledge all the data providers who make anonymised data available for research. The Centre for Trials Research and PRIME Centre Wales is funded by Health and Care Research Wales and Cancer Research UK. Open access This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/ licences/by/4.0/).
Funding Information:
No funding was granted for the completion of this study. The lead author was granted a monetary award from the Wolfson Foundation (Wolfson Intercalated Award) to help their completion of this research as part of their intercalated Bachelor of Science degree. This funding was not associated with the study design, result analyses, write-up, or the decision to submit this article for publication. Additionally, no members of the Wolfson Foundation were involved in the completion of this research. Ethical Approval Access to the data required for the completion of this study was approved by the Health and Care Research Wales Research Ethics Committee and the Health Research Authority Confidentiality Advisory Group committee (reference: 16/WA/0166).
Publisher Copyright:
© 2022 Royal College of General Practitioners. All rights reserved.
Keywords
- child health
- clinical prediction rule
- general practice
- retrospective studies
- primary health care
- International Classification of Diseases
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