Michael Moore1, Beth Stuart2, Mark Lown2, Ann Van den Bruel3, Sue Smith3, Kyle Knox3, Matthew J Thompson4, Paul Little2. 1. University of Southampton, Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom mvm198@soton.ac.uk. 2. University of Southampton, Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom. 3. University of Oxford, Nuffield Department of Primary Health Care Sciences, Radcliffe Observatory Quarter, Oxford, United Kingdom. 4. University of Washington, Seattle, Washington.
Abstract
PURPOSE: Presentation with acute lower respiratory tract infection (LRTI) in primary care is common. The aim of this study was to help clinicians treat patients presenting with LRTI in primary care by identifying those at risk of serious adverse outcomes (death, admission, late-onset pneumonia). METHODS: In a prospective cohort study of patients presenting with LRTI symptoms, patient characteristics and clinical findings were recorded and adverse events identified over 30 days by chart review. Multivariable logistic regression analyses identified predictors of adverse outcomes. RESULTS: Participants were recruited from 522 UK practices in 2009-2013. The analysis was restricted to the 28,846 adult patients not referred immediately to the hospital. Serious adverse outcomes occurred in 325/28,846 (1.1%). Eight factors were independently predictive; these characterized symptom severity (absence of coryza, fever, chest pain, and clinician-assessed severity), patient vulnerability (age >65 years, comorbidity), and physiological impact (oxygen saturation <95%, low blood pressure). In aggregate, the 8 features had moderate predictive value (area under the receiver operating characteristic curve 0.71, 95% CI, 0.68-0.74); the 4% of patients with ≥5 features had an approximately 1 in 17 (5.7%) risk of serious adverse outcomes, the 35% with 3 or 4 features had an intermediate risk (1 in 50, 2.0%), and the 61% with ≤2 features had a low (1 in 200, 0.5%) risk. CONCLUSIONS: In routine practice most patients presenting with LRTI in primary care can be identified as at intermediate or low risk of serious outcome.
PURPOSE: Presentation with acute lower respiratory tract infection (LRTI) in primary care is common. The aim of this study was to help clinicians treat patients presenting with LRTI in primary care by identifying those at risk of serious adverse outcomes (death, admission, late-onset pneumonia). METHODS: In a prospective cohort study of patients presenting with LRTI symptoms, patient characteristics and clinical findings were recorded and adverse events identified over 30 days by chart review. Multivariable logistic regression analyses identified predictors of adverse outcomes. RESULTS:Participants were recruited from 522 UK practices in 2009-2013. The analysis was restricted to the 28,846 adult patients not referred immediately to the hospital. Serious adverse outcomes occurred in 325/28,846 (1.1%). Eight factors were independently predictive; these characterized symptom severity (absence of coryza, fever, chest pain, and clinician-assessed severity), patient vulnerability (age >65 years, comorbidity), and physiological impact (oxygen saturation <95%, low blood pressure). In aggregate, the 8 features had moderate predictive value (area under the receiver operating characteristic curve 0.71, 95% CI, 0.68-0.74); the 4% of patients with ≥5 features had an approximately 1 in 17 (5.7%) risk of serious adverse outcomes, the 35% with 3 or 4 features had an intermediate risk (1 in 50, 2.0%), and the 61% with ≤2 features had a low (1 in 200, 0.5%) risk. CONCLUSIONS: In routine practice most patients presenting with LRTI in primary care can be identified as at intermediate or low risk of serious outcome.
Authors: Jolien Teepe; Paul Little; Nori Elshof; Berna D L Broekhuizen; Michael Moore; Beth Stuart; Chris C Butler; Kerenza Hood; Margareta Ieven; Samuel Coenen; Herman Goossens; Theo J M Verheij Journal: Eur Respir J Date: 2015-11-05 Impact factor: 16.671
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Authors: J Macfarlane; W Holmes; P Gard; R Macfarlane; D Rose; V Weston; M Leinonen; P Saikku; S Myint Journal: Thorax Date: 2001-02 Impact factor: 9.139
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Authors: Paul Little; Beth Stuart; Michael Moore; Samuel Coenen; Christopher C Butler; Maciek Godycki-Cwirko; Artur Mierzecki; Slawomir Chlabicz; Antoni Torres; Jordi Almirall; Mel Davies; Tom Schaberg; Sigvard Mölstad; Francesco Blasi; An De Sutter; Janko Kersnik; Helena Hupkova; Pia Touboul; Kerenza Hood; Mark Mullee; Gilly O'Reilly; Curt Brugman; Herman Goossens; Theo Verheij Journal: Lancet Infect Dis Date: 2012-12-19 Impact factor: 25.071
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Authors: Paul Little; Beth Stuart; Sue Smith; Matthew J Thompson; Kyle Knox; Ann van den Bruel; Mark Lown; Michael Moore; David Mant Journal: BMJ Date: 2017-05-22
Authors: C C Butler; K Hood; T Verheij; P Little; H Melbye; J Nuttall; M J Kelly; S Mölstad; M Godycki-Cwirko; J Almirall; A Torres; D Gillespie; U Rautakorpi; S Coenen; H Goossens Journal: BMJ Date: 2009-06-23
Authors: José M Ordóñez-Mena; Thomas R Fanshawe; Chris C Butler; David Mant; Denise Longhurst; Peter Muir; Barry Vipond; Paul Little; Michael Moore; Beth Stuart; Alastair D Hay; Hannah V Thornton; Matthew J Thompson; Sue Smith; Ann Van den Bruel; Victoria Hardy; Laikin Cheah; Derrick Crook; Kyle Knox Journal: Fam Pract Date: 2020-07-23 Impact factor: 2.267
Authors: Birgitta van Bodegraven; Victoria Palin; Chirag Mistry; Matthew Sperrin; Andrew White; William Welfare; Darren M Ashcroft; Tjeerd Pieter van Staa Journal: BMJ Open Date: 2021-01-15 Impact factor: 2.692
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