Article: How Algorithms Can Put Children at Risk

Photo Source: Pexels

Over the past month, nineteen children in the United Kingdom have died from an invasive form of streptococcus A. Their deaths appear linked to a failure of algorithms in the National Health Services telephone health triage system called “NHS 111.” Streptococcus A is a common infection and, in its mild form, causes sore throat often with white spotted, swollen red tonsils. However, Strep A can take on a more invasive form, leading to scarlet fever and a skin infection called impetigo. Strep A can cause debilitating and even fatal toxic shock syndrome and necrotizing fasciitis, also known as flesh-eating disease. (medlineplus.gov) Antibiotics such as penicillin can treat strep A when treated early. More aggressive treatments must attend invasive strep A to prevent long-term injuries such as rheumatic fever and a kidney disease called post-streptococcal glomerulonephritis and, worse, death.

Health officials in the UK have expressed concern that the outbreak of fatal, invasive strep A has not peaked, with more fatalities anticipated. In a recent article examining how kids with strep A failed to get the treatment they needed in time, The Guardian quoted Dr. Neena Modi, a professor of neonatal medicine at Imperial College London, implying the NHS 111 health triage service failed due to algorithms. She said, “These algorithms have been shown time and again to not be sensitive enough to actually separate out the critically ill child from those who have milder symptoms.” (theguardian.com) The NHS 111 system also came under fire for its mismanagement of COVID-19 patients, some of whom died as a result of not getting the care they needed due to mismanagement of cases by the system. (skynews.com)

The NHS 111 system was designed as an advice service to direct the most serious cases to hospitals to treat the very sick and lower the burden of unnecessary emergency room visits. The free-to-call, non-emergency NHS 111 works through the telephone, whereby sick people or their caregivers call 111 and speak with a non-medical professional. The frontline non-clinical “Health Advisors” record the patient’s symptoms and use a clinical support tool that uses a computer-based system to determine what course of action should follow. If the condition appears serious, the case gets escalated to healthcare professionals. (digital.nhs.uk) The system uses a series of algorithms linked together to decide the severity of the health situation and recommend a course of action and level of urgency.

The tragic deaths of 19 children in the United Kingdom from strep A have shown light on the imperfect algorithms that guide the NHS 111 medical triage system. In the UK, the National Health Service developed a digital clinical support tool called NHS 111 to field calls from patients across the realm to reduce the burden on the national healthcare system. NHS 111 uses non-clinical, specially trained health specialists and a series of algorithms to recommend a sick individual’s proper course of action. Depending on the severity of the symptoms, NHS 111 decides what steps to take, such as to go to the emergency room or to stay home. The loss of children to a treatable disease such as strep A or the loss of life during the COVID-19 pandemic highlighted the deficiencies in the system in deciding the severity of illness in children and adults. Resource-strapped health systems must look for ways to reduce unnecessary doctor visits and prioritize the genuinely sick. However, if the algorithms driving health triage cannot distinguish the severe from the mildly ill, they need more work before truly earning our trust

Dr. Smith’s career in scientific and information research spans the areas of bioinformatics, artificial intelligence, toxicology, and chemistry. He has published a number of peer-reviewed scientific papers. He has worked over the past seventeen years developing advanced analytics, machine learning, and knowledge management tools to enable research and support high-level decision making. Tim completed his Ph.D. in Toxicology at Cornell University and a Bachelor of Science in chemistry from the University of Washington.

You can buy his book on Amazon in paperback and in kindle format here.