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Predicting illness progression for children with lower respiratory infections in primary care: a prospective cohort and observational study.
- Source :
-
The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2023 Nov 30; Vol. 73 (737), pp. e885-e893. Date of Electronic Publication: 2023 Nov 30 (Print Publication: 2023). - Publication Year :
- 2023
-
Abstract
- Background: Antibiotics are commonly prescribed for children with lower respiratory tract infections (LRTIs), fuelling antibiotic resistance, and there are few prognostic tools available to inform management.<br />Aim: To externally validate an existing prognostic model (STARWAVe) to identify children at low risk of illness progression, and if model performance was limited to develop a new internally validated prognostic model.<br />Design and Setting: Prospective cohort study with a nested trial in a primary care setting.<br />Method: Children aged 6 months to 12 years presenting with uncomplicated LRTI were included in the cohort. Children were randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or if not randomised they participated in a parallel observational study to maximise generalisability. Baseline clinical data were used to predict adverse outcome (illness progression requiring hospital assessment).<br />Results: A total of 758 children participated ( n = 432 trial, n = 326 observational). For predicting illness progression the STARWAVe prognostic model had moderate performance (area under the receiver operating characteristic [AUROC] 0.66, 95% confidence interval [CI] = 0.50 to 0.77), but a new, internally validated model (seven items: baseline severity; respiratory rate; duration of prior illness; oxygen saturation; sputum or a rattly chest; passing urine less often; and diarrhoea) had good discrimination (bootstrapped AUROC 0.83, 95% CI = 0.74 to 0.92) and calibration. A three-item model (respiratory rate; oxygen saturation; and sputum or a rattly chest) also performed well (AUROC 0.81, 95% CI = 0.70 to 0.91), as did a score (ranging from 19 to 102) derived from coefficients of the model (AUROC 0.78, 95% CI = 0.67 to 0.88): a score of <70 classified 89% ( n = 600/674) of children having a low risk (<5%) of progression of illness.<br />Conclusion: A simple three-item prognostic score could be useful as a tool to identify children with LRTI who are at low risk of an adverse outcome and to guide clinical management.<br /> (© The Authors.)
Details
- Language :
- English
- ISSN :
- 1478-5242
- Volume :
- 73
- Issue :
- 737
- Database :
- MEDLINE
- Journal :
- The British journal of general practice : the journal of the Royal College of General Practitioners
- Publication Type :
- Academic Journal
- Accession number :
- 37957022
- Full Text :
- https://doi.org/10.3399/BJGP.2022.0493