Predicting illness progression for children with lower respiratory infections in primary care : a prospective cohort and observational study
© The Authors..
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.
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.
DESIGN AND SETTING: Prospective cohort study with a nested trial in a primary care setting.
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).
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.
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:73 |
|---|---|
| Enthalten in: |
The British journal of general practice : the journal of the Royal College of General Practitioners - 73(2023), 737 vom: 21. Dez., Seite e885-e893 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Little, Paul [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
804826J2HU |
|---|
| Anmerkungen: |
Date Completed 04.12.2023 Date Revised 04.12.2023 published: Electronic-Print Citation Status MEDLINE |
|---|
| doi: |
10.3399/BJGP.2022.0493 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM364486643 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM364486643 | ||
| 003 | DE-627 | ||
| 005 | 20231226095532.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3399/BJGP.2022.0493 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1214.xml |
| 035 | |a (DE-627)NLM364486643 | ||
| 035 | |a (NLM)37957022 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Little, Paul |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predicting illness progression for children with lower respiratory infections in primary care |b a prospective cohort and observational study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.12.2023 | ||
| 500 | |a Date Revised 04.12.2023 | ||
| 500 | |a published: Electronic-Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Authors. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN AND SETTING: Prospective cohort study with a nested trial in a primary care setting | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antibiotic resistance | |
| 650 | 4 | |a antibiotics | |
| 650 | 4 | |a children | |
| 650 | 4 | |a primary health care | |
| 650 | 4 | |a respiratory tract infections | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Amoxicillin |2 NLM | |
| 650 | 7 | |a 804826J2HU |2 NLM | |
| 700 | 1 | |a Becque, Taeko |e verfasserin |4 aut | |
| 700 | 1 | |a Hay, Alastair D |e verfasserin |4 aut | |
| 700 | 1 | |a Francis, Nick A |e verfasserin |4 aut | |
| 700 | 1 | |a Stuart, Beth |e verfasserin |4 aut | |
| 700 | 1 | |a O'Reilly, Gilly |e verfasserin |4 aut | |
| 700 | 1 | |a Thompson, Natalie |e verfasserin |4 aut | |
| 700 | 1 | |a Hood, Kerenza |e verfasserin |4 aut | |
| 700 | 1 | |a Moore, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Verheij, Theo |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The British journal of general practice : the journal of the Royal College of General Practitioners |d 1997 |g 73(2023), 737 vom: 21. Dez., Seite e885-e893 |w (DE-627)NLM012664286 |x 1478-5242 |7 nnns |
| 773 | 1 | 8 | |g volume:73 |g year:2023 |g number:737 |g day:21 |g month:12 |g pages:e885-e893 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.3399/BJGP.2022.0493 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 73 |j 2023 |e 737 |b 21 |c 12 |h e885-e893 | ||