Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study
Open Access
- 13 February 2013
- Vol. 346 (feb13 1), f866
- https://doi.org/10.1136/bmj.f866
Abstract
Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presenting with a febrile illness. Main outcome measures Clinical features were used to categorise each febrile episodes as low, intermediate, or high probability of serious bacterial infection (green, amber, and red zones of the traffic light system); these results were checked (using standard radiological and microbiological tests) for each of the infections of interest and for any serious bacterial infection. Results After combination of the intermediate and high risk categories, the NICE traffic light system had a test sensitivity of 85.8% (95% confidence interval 83.6% to 87.7%) and specificity of 28.5% (27.8% to 29.3%) for the detection of any serious bacterial infection. Of the 1140 cases of serious bacterial infection, 157 (13.8%) were test negative (in the green zone), and, of these, 108 (68.8%) were urinary tract infections. Adding urine analysis (leucocyte esterase or nitrite positive), reported in 3653 (23.1%) episodes, to the traffic light system improved the test performance: sensitivity 92.1% (89.3% to 94.1%), specificity 22.3% (20.9% to 23.8%), and relative positive likelihood ratio 1.10 (1.06 to 1.14). Conclusion The NICE traffic light system failed to identify a substantial proportion of serious bacterial infections, particularly urinary tract infections. The addition of urine analysis significantly improved test sensitivity, making the traffic light system a more useful triage tool for the detection of serious bacterial infections in young febrile children.This publication has 31 references indexed in Scilit:
- Changing Epidemiology of Serious Bacterial Infections in Febrile Infants without Localizing SignsPLOS ONE, 2010
- The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnessesBMJ, 2010
- Occult Bacteremia in the Post-Pneumococcal Conjugate Vaccine Era: Does the Blood Culture Stop Here?Academic Emergency Medicine, 2009
- Assessment and initial management of feverish illness in children younger than 5 years: summary of NICE guidanceBMJ, 2007
- Validating and updating a prediction rule for serious bacterial infection in patients with fever without sourceActa Paediatrica, 2006
- Is procalcitonin useful in early diagnosis of serious bacterial infections in children?Acta Paediatrica, 2005
- The Australasian Triage Scale: Examining emergency department nurses' performance using computer and paper scenariosAnnals of Emergency Medicine, 2004
- Towards Complete and Accurate Reporting of Studies of Diagnostic Accuracy: The STARD InitiativeClinical Chemistry, 2003
- A predictive model to estimate the risk of serious bacterial infections in febrile infantsEuropean Journal of Pediatrics, 1996
- Fever in General Practice I. Frequency and DiagnosesFamily Practice, 1992