Teasing out serious infection in children – while minimizing testing and unnecessary interventions – remains a challenge. To this end, the National Institute for Health and Clinical Excellence in the United Kingdom created a “Traffic Light” clinical assessment tool. This tool, which uses colour, activity, respiratory, hydration, and other features to give a low-, intermediate-, or high-risk assessment.
These authors attempted to validate the tool by retrospectively applying it to a prospective registry of over 15,000 febrile children aged less than 5 years. The primary outcome was correctly classifying a serious bacterial infection as intermediate- or high-risk. And the answer: 85.8% sensitivity and 28.5% specificity. Meh.
108 of the 157 missed cases of SBI were urinary tract infections – for which the authors suggest perhaps urinalysis could be added to the NICE traffic light. This would increase sensitivity to 92.1%, but drop specificity to 22.3% – if you agree with the blanket categorization of UTI as SBI.
Regardless, the AUC for SBI was 0.64 without the UA and 0.61 with the UA – not good at all.
“Accuracy of the “traffic light” clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study”
www.ncbi.nlm.nih.gov/pubmed/23407730