The children in the green category were older, with a median age of 2.8 years (interquartile range 1.4–3.8 years) compared with 2.0 years for children in both the amber (IQR 0.9–3.4 years) and red (IQR 1.1–3.3 years) categories, respectively (data not shown). The majority of children were categorised into amber ( n = 4204, 62.7%), followed by red ( n = 2116, 31.6%) and green ( n = 383, 5.7%). Nearly a quarter of the 6703 children attending general practice were aged between 1 and 2 ( n = 1577, 23.5%, Table 1). To comply with SAIL regulations, data with frequencies <5 were suppressed and presented as ‘<5’ or rounded to the nearest five. 23Īnalyses were performed using IBM SPSS Statistics (version 26). The NICE definitions of fever were used to identify this subgroup: measured or perceived elevation of body temperature above the normal daily variation (≥38 ☌) by a parent or clinician. The second evaluated the traffic light system when applied to a cohort of febrile children, chosen because the traffic light system was created by NICE to assess febrile children specifically. The first assessed the ability of the traffic light system to detect children admitted to hospital (with or without a serious illness), to reduce the impact of incorrect diagnoses coding within the routine data. Further calculations included 95% confidence intervals (CIs) and positive and negative predictive values. This allowed comparison of test performance between ‘high-risk’ and ‘intermediate to high-risk’ populations. To evaluate the test performance of the NICE traffic light system, sensitivity and specificity were calculated separately for two thresholds of test positivity: designation of red category and designation of red or amber category. The aim of this study was to evaluate the accuracy of the NICE traffic light system for predicting serious illness in acutely unwell children aged <5 years presenting to UK general practice. 4, 11 – 13 However, to the authors’ knowledge, no studies have evaluated the NICE traffic light system in UK general practice. 11 Additional studies have evaluated this tool within emergency department settings. Validation of the traffic light system within general practice has been performed once previously in 2013, using a small Dutch cohort of 506 febrile children. 9, 10 This illustrates the importance of an accurate primary care tool to identify those needing secondary care assessment. The recent relaxation of restrictions during the COVID-19 pandemic has led to a dramatic increase in the prevalence of respiratory illness in young children, with emergency departments experiencing high demand from children, many of whom are not seriously ill. Children in the red category should be referred urgently for assessment in hospital. Children in the amber category can either be referred to hospital for assessment or sent home with safety-net advice. 8 This tool categorises children into ‘green’, ‘amber’, or ‘red’ depending on their consulting clinical features corresponding to a low, intermediate, or high risk of serious illness, respectively.Īccording to the tool, children in the green category can be managed at home.

In an effort to help primary care clinicians confidently assess unwell children, the National Institute for Health and Care Excellence (NICE) created the ‘traffic light’ system. 3, 5 Despite this, fear and anxiety in parents with an unwell child are common. 4 The estimated incidence of these illnesses in children presenting to general practice is 1% per year. 3 The majority of acute illnesses are self-limiting viral infections, although a minority of children may have a serious illness such as pneumonia or meningitis. 1, 2 This is primarily because of their presentation at an early stage of illness, where the signs and symptoms of non-serious and serious illnesses can appear similar. Children with acute illnesses are a common presentation in general practice, and can be a diagnostic challenge for clinicians.

Retrospect lighting