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Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care

Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care
Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care
AIMS: To explore the potential use of the CRB-65 rule (based on Confusion, Respiratory rate, Blood pressure and age >65 years) in adults with lower respiratory tract infection (LRTI) in primary care.

METHODS: Primary care clinicians in 13 European countries recorded antibiotic treatment and clinical features for adults with LRTI. Patients recorded daily symptoms. Multilevel regression models determined the association between an elevated CRB-65 score and prolonged moderately severe symptoms, hospitalisation, and time to recovery. Sensitivity analyses used zero imputation.

RESULTS: Respiratory rate and blood pressure were recorded in 22.7% and 31.9% of patients, respectively. A total of 2,690 patients completed symptom diaries. The CRB-65 could be calculated for 339 (12.6%). A score of >1 was not significantly associated with prolonged moderately severe symptoms (odds ratio (OR) 0.42, 95% CI 0.04 to 4.19) or hospitalisations (OR 3.12, 95% CI 0.16 to 60.24), but was associated with prolonged time to self-reported recovery when using zero imputation (hazard ratio (HR) 0.75, 95% CI 0.64 to 0.88).

CONCLUSIONS: Respiratory rate and blood pressure are infrequently measured in adults with LRTI. We found no evidence to support using the CRB-65 rule in the assessment of LRTI in primary care. However, it is unclear whether it is of value if used only in patients where the primary care clinician suspects pneumonia.
risk assessment, lower respiratory tract infections, primary health care, cough, prognosis, CRB-65
1471-4418
65-70
Francis, N.A.
041feacf-540c-49ae-b830-eda31920738b
Cals, J.W.
655c77e6-fb59-4891-be05-9d8b2ae607c3
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
GRACE Project Group
Francis, N.A.
041feacf-540c-49ae-b830-eda31920738b
Cals, J.W.
655c77e6-fb59-4891-be05-9d8b2ae607c3
Butler, C.C.
736f78ad-3e18-4c63-900f-c2249577b645
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Coenen, S.
9afe2a52-9f4f-45bb-b8e5-c6ee3eeb3498
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Francis, N.A., Cals, J.W., Butler, C.C., Hood, K., Verheij, T., Little, P., Goossens, H., Coenen, S. and Moore, M. , GRACE Project Group (2012) Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care. Primary Care Respiratory Journal, 21 (1), 65-70. (doi:10.4104/pcrj.2011.00083). (PMID:21938349)

Record type: Article

Abstract

AIMS: To explore the potential use of the CRB-65 rule (based on Confusion, Respiratory rate, Blood pressure and age >65 years) in adults with lower respiratory tract infection (LRTI) in primary care.

METHODS: Primary care clinicians in 13 European countries recorded antibiotic treatment and clinical features for adults with LRTI. Patients recorded daily symptoms. Multilevel regression models determined the association between an elevated CRB-65 score and prolonged moderately severe symptoms, hospitalisation, and time to recovery. Sensitivity analyses used zero imputation.

RESULTS: Respiratory rate and blood pressure were recorded in 22.7% and 31.9% of patients, respectively. A total of 2,690 patients completed symptom diaries. The CRB-65 could be calculated for 339 (12.6%). A score of >1 was not significantly associated with prolonged moderately severe symptoms (odds ratio (OR) 0.42, 95% CI 0.04 to 4.19) or hospitalisations (OR 3.12, 95% CI 0.16 to 60.24), but was associated with prolonged time to self-reported recovery when using zero imputation (hazard ratio (HR) 0.75, 95% CI 0.64 to 0.88).

CONCLUSIONS: Respiratory rate and blood pressure are infrequently measured in adults with LRTI. We found no evidence to support using the CRB-65 rule in the assessment of LRTI in primary care. However, it is unclear whether it is of value if used only in patients where the primary care clinician suspects pneumonia.

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More information

Published date: March 2012
Keywords: risk assessment, lower respiratory tract infections, primary health care, cough, prognosis, CRB-65
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 350010
URI: http://eprints.soton.ac.uk/id/eprint/350010
ISSN: 1471-4418
PURE UUID: 72c7a56e-6ffc-40e0-890b-21abddfae35c
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 15 Mar 2013 16:29
Last modified: 09 Nov 2021 03:11

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Contributors

Author: N.A. Francis
Author: J.W. Cals
Author: C.C. Butler
Author: K. Hood
Author: T. Verheij
Author: P. Little
Author: H. Goossens
Author: S. Coenen
Author: M. Moore ORCID iD
Corporate Author: GRACE Project Group

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