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Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review
George Edwards1, Louise Newbould2, Charlotte Nesbitt1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Insights
Identifying respiratory tract infections (RTIs) in children requires understanding prognostic indicators. While some signs predict hospitalization, more research is needed to empower parents in recognizing poor prognosis at home.
Area of Science:
- Pediatrics
- Public Health
- Clinical Medicine
Background:
- Respiratory tract infections (RTIs) are a leading cause of primary care consultations for children.
- High demand for healthcare services necessitates better tools for managing childhood illnesses.
- Understanding prognostic factors in pediatric RTIs is crucial for developing effective parental support and interventions.
Purpose of the Study:
- To identify symptoms, signs, and investigation results linked to good and poor prognoses in children aged 1-12 years with RTIs.
- To inform clinical decision-making for children presenting with RTI symptoms in ambulatory care settings.
- To explore prognostic indicators for children managed at home and in healthcare settings.
Main Methods:
- A systematic literature review was conducted across major databases (MEDLINE, EMBASE, Cinahl, Web of Science, Cochrane).
- Studies included children aged 1-12 years with RTIs, focusing on symptoms, signs, and investigations related to prognostic outcomes.
- Study quality was assessed using the QUIPS tool, with 27 studies included, encompassing 34,802 children.
Main Results:
- Respiratory signs, vomiting, fever, dehydration, and tachycardia at initial contact were associated with future hospitalization.
- Limited evidence was found for prognostic indicators related to outcomes other than hospitalization.
- None of the included studies focused on the home management setting for predicting prognosis.
Conclusions:
- Current evidence aids clinicians in stratifying the risk of hospitalization for pediatric RTIs, but not for other prognostic outcomes.
- There is a significant gap in evidence to help parents identify children at risk of poor prognosis.
- Further research is recommended to investigate the potential for parents to predict poor outcomes at home.
Background:
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness.
Aim:
To identify symptoms, signs, and investigation results associated with good and poor prognosis, and clinical decision making in children aged 1-12 years with RTI symptoms, at home and presenting to ambulatory care.
Design And Setting:
Systematic literature review.
Methods:
We searched MEDLINE, EMBASE, Cinahl, Web of Science and the Cochrane database of systematic reviews for studies of children aged 1 to 12 years with a RTI or related condition reporting symptoms, signs and investigation results associated with prognostic outcomes. Quality was assessed using the QUIPS tool.
Results:
We included 27 studies which included 34802 children and measured 192 factors. Nine studies explored future outcomes and the remainder explored clinical management from the initial consultation with the health services. None were conducted in a home setting. Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. Little evidence was available for other outcomes.
Conclusion:
Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
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