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Background: The NICE Traffic Light system was created to facilitate the assessment of unwell children in primary care. No studies have evaluated this tool in UK general practice. Aim: To evaluate the accuracy of this system for detecting serious illness in children presenting to general practice. Design and Setting: Retrospective diagnostic accuracy study, using a cohort of acutely unwell children under five years presenting to general practice in England and Wales. Method: The Traffic Light categories of 6,703 children were linked with hospital data to identify admissions and diagnoses. The sensitivity and specificity of these categories were calculated against the reference standard: a hospital diagnosed serious illness within seven days of GP consultation, measured using ICD-10 codes. Results: 2,116 (31·6%) children were categorised as red; 4,204 (62·7%) amber; and 383 (5·7%) green. 139 (2·1%) children were admitted to hospital within seven days of consultation, of whom 17 (12·2%; 0·3% overall) had a serious illness. The sensitivity of the ‘red’ category (vs. amber/green) was 58·8% (95% confidence interval: 32·9% to 81·6%) and the specificity 68·5% (67·4% to 69·6%). The sensitivity and specificity of ‘red’ and ‘amber’ combined (vs. green) was 100% (80·5% to 100%) and 5·7% (5·2% to 6·3%) respectively. Conclusion: The Traffic Light system cannot accurately detect children admitted with a serious illness, nor those not seriously ill who can be managed at home. This system is not suitable for use as a clinical tool in general practice. Further research is required to update or replace the Traffic Light system.

Original publication




Journal article


British Journal of General Practice


Royal College of General Practitioners

Publication Date



BJGP.2021.0633 - BJGP.2021.0633