The Predictive Value of the NICE “Red Traffic Lights” in Acutely Ill Children. Kerkhof, E., Lakhanpaul, M., Ray, S., Verbakel, J. Y., Van den Bruel, A., Thompson, M., Berger, M. Y., Moll, H. A., & Oostenbrink, R. PLoS ONE, March, 2014. ![The Predictive Value of the NICE “Red Traffic Lights” in Acutely Ill Children [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Objective Early 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 Participants The 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 Measures We 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. Results Almost 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. Conclusions The 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.
@article{kerkhof_predictive_2014,
title = {The {Predictive} {Value} of the {NICE} “{Red} {Traffic} {Lights}” in {Acutely} {Ill} {Children}},
volume = {9},
issn = {1932-6203},
url = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954615/},
doi = {10.1371/journal.pone.0090847},
abstract = {Objective
Early 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 Participants
The 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 Measures
We 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.
Results
Almost 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.
Conclusions
The 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.},
number = {3},
urldate = {2016-05-17},
journal = {PLoS ONE},
author = {Kerkhof, Evelien and Lakhanpaul, Monica and Ray, Samiran and Verbakel, Jan Y. and Van den Bruel, Ann and Thompson, Matthew and Berger, Marjolein Y. and Moll, Henriette A. and Oostenbrink, Rianne},
month = mar,
year = {2014},
pmid = {24633015},
pmcid = {PMC3954615},
}
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{"_id":"TiYbSMwfjDHkJTjpq","bibbaseid":"kerkhof-lakhanpaul-ray-verbakel-vandenbruel-thompson-berger-moll-etal-thepredictivevalueoftheniceredtrafficlightsinacutelyillchildren-2014","author_short":["Kerkhof, E.","Lakhanpaul, M.","Ray, S.","Verbakel, J. Y.","Van den Bruel, A.","Thompson, M.","Berger, M. Y.","Moll, H. A.","Oostenbrink, R."],"bibdata":{"bibtype":"article","type":"article","title":"The Predictive Value of the NICE “Red Traffic Lights” in Acutely Ill Children","volume":"9","issn":"1932-6203","url":"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954615/","doi":"10.1371/journal.pone.0090847","abstract":"Objective Early 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 Participants The 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 Measures We 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. Results Almost 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. Conclusions The 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.","number":"3","urldate":"2016-05-17","journal":"PLoS ONE","author":[{"propositions":[],"lastnames":["Kerkhof"],"firstnames":["Evelien"],"suffixes":[]},{"propositions":[],"lastnames":["Lakhanpaul"],"firstnames":["Monica"],"suffixes":[]},{"propositions":[],"lastnames":["Ray"],"firstnames":["Samiran"],"suffixes":[]},{"propositions":[],"lastnames":["Verbakel"],"firstnames":["Jan","Y."],"suffixes":[]},{"propositions":["Van","den"],"lastnames":["Bruel"],"firstnames":["Ann"],"suffixes":[]},{"propositions":[],"lastnames":["Thompson"],"firstnames":["Matthew"],"suffixes":[]},{"propositions":[],"lastnames":["Berger"],"firstnames":["Marjolein","Y."],"suffixes":[]},{"propositions":[],"lastnames":["Moll"],"firstnames":["Henriette","A."],"suffixes":[]},{"propositions":[],"lastnames":["Oostenbrink"],"firstnames":["Rianne"],"suffixes":[]}],"month":"March","year":"2014","pmid":"24633015","pmcid":"PMC3954615","bibtex":"@article{kerkhof_predictive_2014,\n\ttitle = {The {Predictive} {Value} of the {NICE} “{Red} {Traffic} {Lights}” in {Acutely} {Ill} {Children}},\n\tvolume = {9},\n\tissn = {1932-6203},\n\turl = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954615/},\n\tdoi = {10.1371/journal.pone.0090847},\n\tabstract = {Objective\nEarly 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.\n\nDesign, Setting and Participants\nThe 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.\n\nMain Outcome Measures\nWe 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.\n\nResults\nAlmost 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.\n\nConclusions\nThe 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.},\n\tnumber = {3},\n\turldate = {2016-05-17},\n\tjournal = {PLoS ONE},\n\tauthor = {Kerkhof, Evelien and Lakhanpaul, Monica and Ray, Samiran and Verbakel, Jan Y. and Van den Bruel, Ann and Thompson, Matthew and Berger, Marjolein Y. and Moll, Henriette A. and Oostenbrink, Rianne},\n\tmonth = mar,\n\tyear = {2014},\n\tpmid = {24633015},\n\tpmcid = {PMC3954615},\n}\n\n","author_short":["Kerkhof, E.","Lakhanpaul, M.","Ray, S.","Verbakel, J. Y.","Van den Bruel, A.","Thompson, M.","Berger, M. Y.","Moll, H. A.","Oostenbrink, R."],"key":"kerkhof_predictive_2014","id":"kerkhof_predictive_2014","bibbaseid":"kerkhof-lakhanpaul-ray-verbakel-vandenbruel-thompson-berger-moll-etal-thepredictivevalueoftheniceredtrafficlightsinacutelyillchildren-2014","role":"author","urls":{"Paper":"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954615/"},"metadata":{"authorlinks":{}},"html":""},"bibtype":"article","biburl":"https://bibbase.org/zotero/robin.marlow","dataSources":["ix72eqAAMGCuupBaz"],"keywords":[],"search_terms":["predictive","value","nice","red","traffic","lights","acutely","ill","children","kerkhof","lakhanpaul","ray","verbakel","van den bruel","thompson","berger","moll","oostenbrink"],"title":"The Predictive Value of the NICE “Red Traffic Lights” in Acutely Ill Children","year":2014}