Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study
Alastair D Hay1, Tom Fahey, Tim J Peters
1Health Services Research, Division of Primary Health Care, University of Bristol, Cotham Hill, Bristol. alastair.hay@bristol.ac.uk
Insights
Fever and chest signs in pre-school children with acute cough can predict complications. This clinical prediction rule helps individualize management for better outcomes in pediatric respiratory illness.
Area of Science:
- Pediatric Medicine
- Clinical Epidemiology
- Respiratory Medicine
Background:
- Uncertainty exists regarding which preschool children with acute cough are at higher risk for complications.
- Accurate identification of at-risk children is crucial for appropriate clinical management and resource allocation.
Purpose of the Study:
- To develop a clinical prediction rule to identify preschool children presenting to primary care with acute cough who are most likely to experience complications.
- To aid in the individualized management of acute cough in young children.
Main Methods:
- A prospective cohort study was conducted in eight general practices in the United Kingdom.
- Data on sociodemographic factors, clinical history, and examination findings were collected from preschool children with cough (duration ≤28 days, no asthma).
- Univariable and multivariable logistic regression analyses were used to identify factors independently associated with complications, defined as new symptoms, signs, diagnoses, or hospital admission.
Main Results:
- The pre-test probability of complications was 10%.
- Fever (Odds Ratio [OR] = 5.56) and chest signs (OR = 2.88) were independently associated with complications in multivariable analysis.
- Post-test probabilities of complications ranged from 6% (no fever or chest signs) to 40% (fever and chest signs).
Conclusions:
- A clinical prediction rule incorporating fever and chest signs can help stratify risk for complications in preschool children with acute cough.
- If validated, this rule can support individualized management strategies in primary care settings.
- This tool has the potential to optimize care for pediatric respiratory conditions.
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.
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