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De and colleagues present the validation results of the National Institute for Health and Care Excellence (NICE)“traffic light” system to detect serious bacterial infections in young children with fever. 1 Such research is welcome, because timely recognition of the small number of children with serious bacterial infections among the majority with self limiting infections is difficult and consumes considerable frontline healthcare resources. 2

We recently examined the diagnostic accuracy of several clinical prediction rules, including the NICE traffic light system with any amber or red feature present, in ambulatory care: two low prevalence (primary care) and five intermediate to high prevalence (emergency department) datasets from three different countries. 3 Similar to De and colleagues, we found moderate sensitivity for the high prevalence settings (87.1%, 95% CI 82.5 to 90.9). 4