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Is the NICE traffic light system fit-for-purpose for children presenting with undifferentiated acute illness in primary care?
  1. Megan Hedd Blyth1,
  2. Rebecca Cannings-John2,
  3. Alastair D Hay3,
  4. Christopher C Butler4,
  5. Kathryn Hughes1
  1. 1 Division of Population Medicine, Cardiff University, Cardiff, UK
  2. 2 Centre for Trials Research, Cardiff University, Cardiff, UK
  3. 3 Division of Primary Health Care, University of Bristol, Bristol, UK
  4. 4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Megan Hedd Blyth, Cardiff University, Cardiff CF10 3AT, UK; BlythM1{at}


Background The National Institute of Clinical Excellence (NICE) traffic light system uses children’s symptoms and signs to categorise acute infections into red, amber and green. To our knowledge, no study has described the proportion of children with acute undifferentiated illness who fall into these categories in primary care, which is important since red and amber children are considered at higher risk of serious illness requiring urgent secondary care assessment.

Aim To estimate the proportion of acutely unwell children presenting to primary care classified by the NICE traffic light system as red, amber or green, and to describe their initial management.

Design and setting Secondary analysis of the Diagnosis of Urinary Tract infection in Young children prospective cohort study.

Method 6797 children under 5 years presenting to 225 general practices with acute undifferentiated illness were retrospectively mapped to the NICE traffic light system by a panel of general practitioners.

Results 6406 (94%) children were classified as NICE red (32%) or amber (62%) with 1.6% red and 0.3%, respectively, referred the same day for hospital assessment; and 46% and 31%, respectively, treated with antibiotics. The remaining 385 (6%) were classified green, with none referred and 27% treated with antibiotics. Results were robust to sensitivity analyses.

Conclusion The majority of children presenting to UK primary care with acute undifferentiated illness meet red or amber NICE traffic light criteria,with only 6% classified as low risk, making it unfit for use in general practice. Research is urgently needed to establish as triage system suitable for general practice.

  • paediatrics
  • primary health care

Data availability statement

No data are available. .

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  • Contributors MHB is the lead author and contributed to the conception and design of the work; data analysis and interpretation; drafting of the article; critical revision of the article and final approval of the version to be published. RC-J contributed to the conception and design of the work, data analysis, drafting of the article and final approval. KH contributed to the conception and design of the work, data analysis and interpretation, drafting, supervision and final approval. ADH contributed to data collection, critical revision of the article and final approval of the version to be published. CCB contributed to data collection and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.