ArticlePloS one2014
The predictive value of the NICE "red traffic lights" in acutely ill children.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and meta-analysis.European journal of pediatrics · 2021Pooled it
- Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review.PloS one · 2021Pooled it
- The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review.Frontiers in pediatrics · 2019Pooled it
- Reducing inappropriate antibiotic prescribing for children in primary care: a cluster randomised controlled trial of two interventions.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Trial
- Trial
- Prospective multicenter evaluation of adherence to the Dutch guideline for children aged 0-16 years with fever without a source-febrile illness in children (FINCH) study.European journal of pediatrics · 2024Observational
- SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern.Acta paediatrica (Oslo, Norway : 1992) · 2022Article
- Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Article
- Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department.Frontiers in pediatrics · 2022Article
- A NICE combination for predicting hospitalisation at the Emergency Department: a European multicentre observational study of febrile children.The Lancet regional health. Europe · 2021Article
- Article
- Fever in Children: Pearls and Pitfalls.Children (Basel, Switzerland) · 2017Review
- Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar - Aetiologies, Antibiotic Treatment and Outcome.PloS one · 2016Article
- Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.BMJ open · 2015Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveEarly recognition and treatment of febrile children with serious infections (SI) improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value of the National Institute for Health and Clinical Excellence (NICE) most severe alarming signs or symptoms to identify SI in children. DESIGN, SETTING AND
participantsThe 16 most severe ("red") features of the NICE traffic light system were validated in seven different primary care and emergency department settings, including 6,260 children presenting with acute illness.
main outcome measuresWe focussed on the individual predictive value of single red features for SI and their combinations. Results were presented as positive likelihood ratios, sensitivities and specificities. We categorised "general" and "disease-specific" red features. Changes in pre-test probability versus post-test probability for SI were visualised in Fagan nomograms.
resultsAlmost all red features had rule-in value for SI, but only four individual red features substantially raised the probability of SI in more than one dataset: "does not wake/stay awake", "reduced skin turgor", "non-blanching rash", and "focal neurological signs". The presence of ≥ 3 red features improved prediction of SI but still lacked strong rule-in value as likelihood ratios were below 5.
conclusionsThe rule-in value of the most severe alarming signs or symptoms of the NICE traffic light system for identifying children with SI was limited, even when multiple red features were present. Our study highlights the importance of assessing the predictive value of alarming signs in clinical guidelines prior to widespread implementation in routine practice.
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