BACKGROUND: There is uncertainty about which children with cough are most and least likely to experience complications. AIM: To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough. DESIGN OF STUDY: Prospective cohort study. SETTING: Eight general practices in Leicestershire, United Kingdom. METHOD: Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, clinical history, and examination data were collected and univariable logistic regression used to explore the associations with complications. These were defined as any new symptom, sign or diagnosis identified by a primary care clinician at a parent initiated reconsultation, or hospital admission, before cough resolution. Those factors with stronger relationships (P< 0.2) were then modelled using multivariable logistic regression to identify the factors independently associated with complications. RESULTS: The pre-test probability of complications was 10%. On univariable analysis, fever (odds ratio [OR] = 4.86; 95% confidence interval [CI] = 1.74 to 13.6), chest signs (OR = 2.72; CI = 1.06 to 6.96), and tachypnoea (OR = 3.80; CI = 1.22 to 11.8) were associated with complications. On multivariable analysis, only fever (OR = 5.56; CI = 1.75 to 17.6) and chest signs (OR = 2.88; CI = 1.02 to 8.05) were independently associated with complications. These ORs translate into post-test probabilities of complications of 6% for children with neither fever nor chest signs, 18% for children with chest signs, 28% for children with fever, and 40% for children with fever and chest signs. CONCLUSIONS: If validated, this clinical prediction rule could be used to individualise the management of acute cough in pre-school children.
BACKGROUND: There is uncertainty about which children with cough are most and least likely to experience complications. AIM: To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough. DESIGN OF STUDY: Prospective cohort study. SETTING: Eight general practices in Leicestershire, United Kingdom. METHOD: Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, clinical history, and examination data were collected and univariable logistic regression used to explore the associations with complications. These were defined as any new symptom, sign or diagnosis identified by a primary care clinician at a parent initiated reconsultation, or hospital admission, before cough resolution. Those factors with stronger relationships (P< 0.2) were then modelled using multivariable logistic regression to identify the factors independently associated with complications. RESULTS: The pre-test probability of complications was 10%. On univariable analysis, fever (odds ratio [OR] = 4.86; 95% confidence interval [CI] = 1.74 to 13.6), chest signs (OR = 2.72; CI = 1.06 to 6.96), and tachypnoea (OR = 3.80; CI = 1.22 to 11.8) were associated with complications. On multivariable analysis, only fever (OR = 5.56; CI = 1.75 to 17.6) and chest signs (OR = 2.88; CI = 1.02 to 8.05) were independently associated with complications. These ORs translate into post-test probabilities of complications of 6% for children with neither fever nor chest signs, 18% for children with chest signs, 28% for children with fever, and 40% for children with fever and chest signs. CONCLUSIONS: If validated, this clinical prediction rule could be used to individualise the management of acute cough in pre-school children.
Authors: Michael Moore; Beth Stuart; Samuel Coenen; Chris C Butler; Herman Goossens; Theo J M Verheij; Paul Little Journal: Br J Gen Pract Date: 2014-02 Impact factor: 5.386
Authors: Michael Moore; Beth Stuart; Fd Richard Hobbs; Chris C Butler; Alastair D Hay; John Campbell; Brendan C Delaney; Sue Broomfield; Paula Barratt; Kerenza Hood; Hazel Everitt; Mark Mullee; Ian Williamson; David Mant; Paul Little Journal: Br J Gen Pract Date: 2017-08-14 Impact factor: 5.386
Authors: Niamh M Redmond; Rachel Davies; Hannah Christensen; Peter S Blair; Andrew M Lovering; John P Leeming; Peter Muir; Barry Vipond; Hannah Thornton; Margaret Fletcher; Brendan Delaney; Paul Little; Matthew Thompson; Tim J Peters; Alastair D Hay Journal: BMC Health Serv Res Date: 2013-08-17 Impact factor: 2.655
Authors: Paul Little; Beth Stuart; F D Richard Hobbs; Chris C Butler; Alastair D Hay; John Campbell; Brendan Delaney; Sue Broomfield; Paula Barratt; Kerenza Hood; Hazel Everitt; Mark Mullee; Ian Williamson; David Mant; Michael Moore Journal: BMJ Date: 2013-11-25