Assessing the Deteriorating Child: The Role of the Traffic Light System and the National Early Warning Score (NEWS)

Children who are unwell can deteriorate rapidly and develop life-threatening complications. Therefore, it is essential for health care providers to be able to recognise and respond to the signs of deterioration in children and to escalate their care appropriately.

Two tools that can assist health care providers in assessing the deteriorating child are the traffic light system and the National Early Warning Score (NEWS).

The traffic light system is a tool developed by the National Institute for Health and Care Excellence (NICE) to help health care providers identify children who are at risk of serious illness and to decide on the appropriate level and location of care1. The tool categorises children into green, amber, or red depending on their clinical features, corresponding to a low, intermediate, or high risk of serious illness, respectively.

The traffic light system covers four domains: behaviour, circulation, respiratory, and other features. Each domain has a list of signs and symptoms that indicate the level of risk for the child. For example, in the behaviour domain, a child who is alert and responsive is green, a child who is not responding normally to social cues or has a decreased activity level is amber, and a child who is unconscious or has a weak or high-pitched cry is red.

The traffic light system is intended to be used as a guide, not a substitute for clinical judgement. It does not provide a diagnosis or a definitive management plan for the child. It simply helps to identify those children who need urgent attention and referral, and those who can be safely managed in primary care or at home.

The National Early Warning Score (NEWS) is a tool developed by the Royal College of Physicians (RCP) to standardise the assessment and response to acute illness in adults2. However, it has also been adapted for use in children by various organisations and authorities, such as NHS England, NHS Improvement, and the Healthcare Improvement Studies Institute (THIS Institute)3 4 5.

The NEWS is based on six physiological parameters: respiratory rate, oxygen saturation, temperature, blood pressure, pulse rate, and level of consciousness. Each parameter is assigned a score from 0 to 3 depending on its deviation from the normal range. The scores are then added up to give a total score that reflects the severity of the child’s condition.

The NEWS also considers the need for supplemental oxygen and any new confusion in the child. These factors are given an additional score of 2 each. The NEWS also includes clinical judgement and escalation protocols to guide health care providers on how to respond to different scores.

The NEWS is intended to be used as an adjunct, not an alternative to clinical assessment. It does not replace the need for clinical reasoning and holistic care of the child. It simply helps to standardise the detection and communication of deterioration in children and to trigger timely interventions.

Both the traffic light system and the NEWS have been shown to be useful tools for assessing the deteriorating child in various settings and populations6 . However, they are not without limitations and challenges. Some of the issues that have been raised include:

The accuracy and validity of the tools in different settings and populations
The availability and accessibility of the tools in various formats and platforms
The implementation and integration of the tools into routine practice
The evaluation and feedback of the tools’ impact and outcomes

Therefore, further research and development are needed to update or replace these tools with more reliable and user-friendly tools that can support health care providers in assessing the deteriorating child.

The traffic light system is a tool that helps healthcare professionals identify children at risk of deterioration. If you want to learn more about it and how to care for the deteriorating child, you can read the Practitioner Development UK article The Traffic Light System: Identifying Children at Risk of Deterioration. You can also enrol in our deteriorating child course on the PDUK website.

References:

Traffic light system for identifying risk of serious illness in … – NICE. (2019, September). Retrieved from https://www.nice.org.uk/guidance/ng143/resources/support-for-education-and-learning-educational-resource-traffic-light-table-pdf-6960664333

Accuracy of the NICE traffic light system in children presenting to … (2012, July). Retrieved from https://bjgp.org/content/72/719/e398

National Early Warning Score (NEWS) 2: Standardising the assessment … – RCP London. (2017, December). Retrieved from https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

National Early Warning Score (NEWS) 2: paediatric modification … – RCPCH. (2020, March). Retrieved from https://www.rcpch.ac.uk/resources/national-early-warning-score-news-2-paediatric-modification