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Hounkpatin H, Stuart B, Zhu S, Yao G, Moore M, Löffler C, Little P, Kenealy T, Gillespie D, Francis NA, Bostock J, Becque T, Arroll B, Altiner A, Alonso-Coello P, Hay AD. Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data. Br J Gen Pract 2023; 73:e196-e203. [PMID: 36823057 PMCID: PMC9975977 DOI: 10.3399/bjgp.2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration. AIM To describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories. DESIGN AND SETTING The study included data about 9103 adults and children from 12 primary care studies. METHOD A latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed. RESULTS In total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: 'rapid (6 days)' (90% of participants recovered within 6 days) in 52.0%; 'intermediate (10 days)' (28.9%); 'slow progressive improvement (27 days)' (12.5%); and 'slow improvement with initial high symptom burden (27 days)' (6.6%). For cough, being aged 16-64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with <16 years), higher presenting illness baseline severity (OR 1.51, 95% CI = 1.12 to 2.03), presence of lung disease (OR 1.78, 95% CI = 1.44 to 2.21), and median and above illness duration before consultation (≥7 days) (OR 1.99, 95% CI = 1.68 to 2.37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively). CONCLUSION Older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.
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Affiliation(s)
- Hilda Hounkpatin
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth Stuart
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Shihua Zhu
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Department of Health Science, University of Leicester, Leicester, UK
| | - Michael Moore
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Timothy Kenealy
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - David Gillespie
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Nick A Francis
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jennifer Bostock
- Division of Health and Social Care Research, King's College London, London, UK
| | - Taeko Becque
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Attila Altiner
- Department of Health Science, University of Leicester, Leicester, UK
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Divaret‐Chauveau A, Mauny F, Hose A, Depner M, Dalphin M, Kaulek V, Barnig C, Schaub B, Schmausser‐Hechfellner E, Renz H, Riedler J, Pekkanen J, Karvonen AM, Täubel M, Lauener R, Roduit C, Vuitton DA, von Mutius E, Demoulin‐Alexikova S, Kirjavainen P, Roponen M, Laurent L, Theodorou J, Böck A, Pechlivanis S, Ege M, Genuneit J, Illi S, Kabesch M, Pfefferle P, Frei R. Trajectories of cough without a cold in early childhood and associations with atopic diseases. Clin Exp Allergy 2022; 53:429-442. [PMID: 36453463 DOI: 10.1111/cea.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood. OBJECTIVES The objective of the study was to describe the latent class trajectories of cough from one to 10 years old and analyse their association with wheezing, atopy and allergic diseases. METHODS Questions about cough, wheeze and allergic diseases were asked at 1, 1.5, 2, 3, 4, 5, 6 and 10 years of age in the European prospective cohort of Protection against Allergy: STUdy in Rural Environment (PASTURE). Specific IgE assays were performed at 10 years of age. Questions regarding a cough without a cold were used to build a latent class model of cough over time. RESULTS Among the 961 children included in the study, apart from the never/infrequent trajectory (59.9%), eight trajectories of cough without a cold were identified: five grouped acute transient classes (24.1%), moderate transient (6.8%), late persistent (4.8%) and early persistent (4.4%). Compared with the never/infrequent trajectory, the other trajectories were significantly associated with wheezing, asthma and allergic rhinitis. For asthma, the strongest association was with the early persistent trajectory (ORa = 31.00 [14.03-68.51]), which was inversely associated with farm environment (ORa = 0.39 [0.19-0.77]) and had a high prevalence of cough triggers and unremitting wheeze. Late and early persistent trajectories were also associated with food allergy. Atopic sensitization was only associated with the late persistent trajectory. CONCLUSION Late and early persistent coughs without a cold are positively associated with atopic respiratory diseases and food allergy. Children having recurrent cough without a cold with night cough and triggers would benefit from an asthma and allergy assessment. Growing up on a farm is associated with reduced early persistent cough.
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Affiliation(s)
- Amandine Divaret‐Chauveau
- Paediatric Allergy Department University Hospital of Nancy Vandoeuvre‐les‐Nancy France
- EA3450 Développement Adaptation et Handicap (DevAH) University of Lorraine Nancy France
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
| | - Frederic Mauny
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
- Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique CIC Inserm 143, University Hospital of Besançon Besançon France
| | - Alexander Hose
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
| | - Martin Depner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | | | - Vincent Kaulek
- Respiratory Diseases Department University Hospital of Besançon Besançon France
| | - Cindy Barnig
- Respiratory Diseases Department University Hospital of Besançon Besançon France
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte‐Greffon‐Tumeur, Ingénierie Cellulaire et Génique Bourgogne Franche‐Comté University Besançon France
| | - Bianca Schaub
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
| | - Elisabeth Schmausser‐Hechfellner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | - Harald Renz
- Institute for Medicine Laboratory, Pathobiochemistry and Molecular Diagnostics Philipps‐University Marburg Marburg Germany
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology Sechenov University Moscow Russia
| | | | - Juha Pekkanen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
- Department of Public Health University of Helsinki Helsinki Finland
| | - Anne M. Karvonen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Martin Täubel
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Roger Lauener
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital of Eastern Switzerland St Gallen Switzerland
| | - Caroline Roduit
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- University Children's Hospital Zurich Zurich Switzerland
| | | | - Erika von Mutius
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
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McGeoch LJ, Thornton HV, Blair PS, Christensen H, Turner NL, Muir P, Vipond B, Redmond NM, Turnbull S, Hay AD. Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study. PLoS One 2022; 17:e0268131. [PMID: 35552562 PMCID: PMC9098075 DOI: 10.1371/journal.pone.0268131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The association between upper respiratory tract microbial positivity and illness prognosis in children is unclear. This impedes clinical decision-making and means the utility of upper respiratory tract microbial point-of-care tests remains unknown. We investigated for relationships between pharyngeal microbes and symptom severity in children with suspected respiratory tract infection (RTI). METHODS Baseline characteristics and pharyngeal swabs were collected from 2,296 children presenting to 58 general practices in Bristol, UK with acute cough and suspected RTI between 2011-2013. Post-consultation, parents recorded the severity of six RTI symptoms on a 0-6 scale daily for ≤28 days. We used multivariable hurdle regression, adjusting for clinical characteristics, antibiotics and other microbes, to investigate associations between respiratory microbes and mean symptom severity on days 2-4 post-presentation. RESULTS Overall, 1,317 (57%) children with complete baseline, microbiological and symptom data were included. Baseline characteristics were similar in included participants and those lacking microbiological data. At least one virus was detected in 869 (66%) children, and at least one bacterium in 783 (60%). Compared to children with no virus detected (mean symptom severity score 1.52), adjusted mean symptom severity was 0.26 points higher in those testing positive for at least one virus (95% CI 0.15 to 0.38, p<0.001); and was also higher in those with detected Influenza B (0.44, 0.15 to 0.72, p = 0.003); RSV (0.41, 0.20 to 0.60, p<0.001); and Influenza A (0.25, -0.01 to 0.51, p = 0.059). Children positive for Enterovirus had a lower adjusted mean symptom severity (-0.24, -0.43 to -0.05, p = 0.013). Children with detected Bordetella pertussis (0.40, 0.00 to 0.79, p = 0.049) and those with detected Moraxella catarrhalis (-0.76, -1.06 to -0.45, p<0.001) respectively had higher and lower mean symptom severity compared to children without these bacteria. CONCLUSIONS There is a potential role for upper respiratory tract microbiological point-of-care tests in determining the prognosis of childhood RTIs.
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Affiliation(s)
- Luke J. McGeoch
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hannah V. Thornton
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter S. Blair
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nicholas L. Turner
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, United Kingdom
| | - Peter Muir
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, United Kingdom
| | - Barry Vipond
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, United Kingdom
| | - Niamh M. Redmond
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Centre d’épidémiologie et de recherche en santé des populations (CERPOP), Université Toulouse III—Paul Sabatier, Toulouse, France
| | - Sophie Turnbull
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Stuart B, Hounkpatin H, Becque T, Yao G, Zhu S, Alonso-Coello P, Altiner A, Arroll B, Böhning D, Bostock J, Bucher HC, Chao J, de la Poza M, Francis N, Gillespie D, Hay AD, Kenealy T, Löffler C, McCormick DP, Mas-Dalmau G, Muñoz L, Samuel K, Moore M, Little P. Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis. BMJ 2021; 373:n808. [PMID: 33910882 PMCID: PMC8080136 DOI: 10.1136/bmj.n808] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect. DESIGN Systematic review and individual patient data meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing. MAIN OUTCOME MEASURES The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale. RESULTS Data were obtained from nine randomised controlled trials and four observational studies, totalling 55 682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference -0.003, 95% confidence interval -0.12 to 0.11) or delayed versus no antibiotics (0.02, -0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62, 95% confidence interval 0.30 to 1.27) and delayed versus immediate antibiotics (0.78, 0.53 to 1.13). A significant reduction in reconsultation rates (odds ratio 0.72, 95% confidence interval 0.60 to 0.87) and an increase in patient satisfaction (adjusted mean difference 0.09, 0.06 to 0.11) were observed in delayed versus no antibiotics. The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0.10, 95% confidence interval 0.03 to 0.18), but no increased severity was found in the older age group. CONCLUSIONS Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children. STUDY REGISTRATION PROSPERO CRD42018079400.
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Affiliation(s)
- Beth Stuart
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hilda Hounkpatin
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Taeko Becque
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Biostatistics Research Group, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Shihua Zhu
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jennifer Bostock
- Division of Health and Social Care Research, King's College London, London, UK
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics (CEB), University Hospital Basel and University of Basel, Switzerland
| | - Jennifer Chao
- Pediatric Emergency Medicine, State University of New York Downstate, Brooklyn, New York, USA
| | - Mariam de la Poza
- Institut Català de la Salut, CAP Doctor Carles Ribas, Foc 112, Barcelona, Spain
| | - Nick Francis
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Gillespie
- Centre for Trials Research, School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Timothy Kenealy
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - David P McCormick
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Gemma Mas-Dalmau
- Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laura Muñoz
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Kirsty Samuel
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Michael Moore
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- Academic Unit of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Edwards G, Newbould L, Nesbitt C, Rogers M, Morris RL, Hay AD, Campbell SM, Hayward G. Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review. PLoS One 2021; 16:e0249533. [PMID: 33872323 PMCID: PMC8055026 DOI: 10.1371/journal.pone.0249533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. Aim To identify symptoms, signs, and investigation results associated with good and poor prognosis, and clinical decision making in children aged 1–12 years with RTI symptoms, at home and presenting to ambulatory care. Design and setting Systematic literature review. Methods We searched MEDLINE, EMBASE, Cinahl, Web of Science and the Cochrane database of systematic reviews for studies of children aged 1 to 12 years with a RTI or related condition reporting symptoms, signs and investigation results associated with prognostic outcomes. Quality was assessed using the QUIPS tool. Results We included 27 studies which included 34802 children and measured 192 factors. Nine studies explored future outcomes and the remainder explored clinical management from the initial consultation with the health services. None were conducted in a home setting. Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. Little evidence was available for other outcomes. Conclusion Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
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Affiliation(s)
- George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Louise Newbould
- Social Policy Research Unit, University of York, York, United Kingdom
| | - Charlotte Nesbitt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Miranda Rogers
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca L. Morris
- Division of Population Health, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Stephen M. Campbell
- Division of Population Health, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Respiratory infections in children: an appropriateness study of when parents should home care or seek medical help. Br J Gen Pract 2021; 71:e140-e147. [PMID: 33318088 PMCID: PMC7744039 DOI: 10.3399/bjgp20x713933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear. Aim To develop symptom-based criteria to support parental medical help seeking for children with RTIs. Design and setting A research and development/University of California Los Angeles (RAND/UCLA) appropriateness study to obtain consensus on children’s RTI symptoms appropriate for home, primary, or secondary health care in the UK. Method A multidisciplinary panel of 12 healthcare professionals — six GPs, two pharmacists, two NHS 111 nurses, and two emergency paediatric consultants — rated the appropriateness of care setting for 1134 scenarios in children aged >12 months. Results Panellists agreed that home care would be appropriate for children with ≤1 week of ‘normal’ infection symptoms (cough, sore throat, ear pain, and/or runny nose, with or without eating adequately and normal conscious level). The presence of ≥2 additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the emergency department was considered appropriate when ≥3 symptoms were present and included shortness of breath or wheezing. Conclusion The authors have defined the RTI symptoms that parents might regard as ‘normal’ and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs.
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Schot MJC, Dekker ARJ, van Werkhoven CH, van der Velden AW, Cals JWL, Broekhuizen BDL, Hopstaken RM, de Wit NJ, Verheij TJM. Burden of disease in children with respiratory tract infections in primary care: diary-based cohort study. Fam Pract 2019; 36:723-729. [PMID: 31166598 PMCID: PMC7006994 DOI: 10.1093/fampra/cmz024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a common reason for children to consult in general practice. Antibiotics are often prescribed, in part due to miscommunication between parents and GPs. The duration of specific respiratory symptoms has been widely studied. Less is known about illness-related symptoms and the impact of these symptoms on family life, including parental production loss. Better understanding of the natural course of illness-related symptoms in RTI in children and impact on family life may improve GP-parent communication during RTI consultations. OBJECTIVE To describe the general impact of RTI on children and parents regarding illness-related symptoms, absenteeism from childcare, school and work, use of health care facilities, and the use of over-the-counter (OTC) medication. METHODS Prospectively collected diary data from two randomized clinical trials in children with RTI in primary care (n = 149). Duration of symptoms was analysed using survival analysis. RESULTS Disturbed sleep, decreased intake of food and/or fluid, feeling ill and/or disturbance at play or other daily activities are very common during RTI episodes, with disturbed sleep lasting longest. Fifty-two percent of the children were absent for one or more days from childcare or school, and 28% of mothers and 20% of fathers reported absence from work the first week after GP consultation. Re-consultation occurred in 48% of the children. OTC medication was given frequently, particularly paracetamol and nasal sprays. CONCLUSION Appreciation of, and communication about the general burden of disease on children and their parents, may improve understanding between GPs and parents consulting with their child.
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Affiliation(s)
- M J C Schot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A R J Dekker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W L Cals
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - R M Hopstaken
- Star-shl diagnostic centers, Etten-Leur, The Netherlands
| | - N J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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