‘Traffic light’ guide for pediatric bacterial infection needs refining

By Helen Albert, Senior medwireNews Reporter

Study results suggest that a "traffic light" system for categorizing the severity of infections in children fails to detect a substantial number of serious bacterial infections, particularly urinary tract infections.

However, the team notes that adding urine analysis to the traffic light system, as advocated by the UK National Institute of Health and Clinical Excellence (NICE), significantly improved the sensitivity of the test, making it "a more useful triage tool for the detection of serious bacterial infections in young febrile children."

Sukanya De (University of Sydney, Australia) and colleagues assessed the accuracy of the NICE traffic light system for detecting urinary tract infection, pneumonia, and bacteremia in 15,781 young children under the age of 5 years admitted to the emergency department of the Children's Hospital at Westmead, Sydney, between July 2004 and June 2006.

The system is designed to help clinicians rapidly check likely infection status by assessing skin coloration, activity, respiratory function, hydration, and other factors such as presence of 5 or more days of fever. Severity of suggested infection is estimated by whether symptoms indicate that the child is at low risk (green), intermediate risk (amber), or high risk (red) for serious illness.

Writing in the BMJ, De and co-authors report that the NICE traffic light system accurately identified 983 of 1140 cases of serious bacterial infection over the study period, translating to a sensitivity of 85.8% and a specificity of 28.5%.

Of the 157 serious infections that were not identified using the traffic light system, 108 (68.8%) were urinary tract infections. An analysis of 3653 patients in whom urine analysis was carried out showed that adding this test to the traffic light system improved the sensitivity to 92.1% and produced a relative positive likelihood ratio of 1.10, although the specificity was still low, at 22.3%.

"With the addition of this relatively simple, non-invasive, and inexpensive near patient test, the traffic light system may be a useful triage tool for healthcare professionals for the initial evaluation of likelihood of serious bacterial infections in young febrile children," say the researchers.

"Clinical effectiveness and acceptability of the system for the detection of serious illnesses need to be assessed through randomized control trials," they conclude.

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