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Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study

Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study
Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study
Objective: to document whether elements of a structured history and examination predict adverse outcome of acute sore throat.

Design: prospective clinical cohort.

Setting: primary care.

Participants: 610 adults with acute sore throat (?2 weeks’ duration).

Main outcome measures: common suppurative complications (quinsy or peritonsillar abscess, otitis media, sinusitis, impetigo or cellulitis) and reconsultation with new or unresolving symptoms within one month.

Results: complications were assessed reliably (inter-rater ?=0.95). 1.3% (177/13<thin>445) of participants developed complications overall and 14.2% (1889/13<thin>288) reconsulted with new or unresolving symptoms. Independent predictors of complications were severe tonsillar inflammation (documented among 13.0% (1652/12<thin>717); odds ratio 1.92, 95% confidence interval 1.28 to 2.89) and severe earache (5% (667/13<thin>323); 3.02, 1.91 to 4.76), but the model including both variables had modest prognostic utility (bootstrapped area under the receiver operator curve 0.61, 0.57 to 0.65), and 70% of complications (124/177) occurred when neither was present. Clinical prediction rules for bacterial infection (Centor criteria and FeverPAIN) also predicted complications, but predictive values were also poor and most complications occurred with low scores (67% (118/175) scoring ?2 for Centor; 126/173 (73%) scoring ?2 for FeverPAIN). Previous medical problems, sex, temperature, and muscle aches were independently but weakly associated with reconsultation with new or unresolving symptoms.

Conclusion: important suppurative complications after an episode of acute sore throat in primary care are uncommon. History and examination and scores to predict bacterial infection cannot usefully identify those who will develop complications. Clinicians will need to rely on strategies such as safety netting or delayed prescription in managing the uncertainty and low risk of complications
0959-8138
1-14
Little, Paul
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Stuart, Beth
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Hobbs, F.D. Richard
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Butler, Chris C.
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Hay, Alastair D.
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Campbell, John
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Delaney, Brendan
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Broomfield, Sue
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Barratt, Paula
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Hood, Karenza
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Everitt, Hazel
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Mullee, Mark
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Williamson, Ian
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Mant, David
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Moore, Michael
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on behalf of the DESCARTE investigators
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
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Hobbs, F.D. Richard
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Butler, Chris C.
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Hay, Alastair D.
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Campbell, John
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Delaney, Brendan
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Broomfield, Sue
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Barratt, Paula
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Hood, Karenza
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Everitt, Hazel
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Mullee, Mark
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Williamson, Ian
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Mant, David
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Moore, Michael
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Little, Paul, Stuart, Beth, Hobbs, F.D. Richard, Butler, Chris C., Hay, Alastair D., Campbell, John, Delaney, Brendan, Broomfield, Sue, Barratt, Paula, Hood, Karenza, Everitt, Hazel, Mullee, Mark, Williamson, Ian, Mant, David and Moore, Michael , on behalf of the DESCARTE investigators (2013) Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study. British Medical Journal, 347 (f6867), 1-14. (doi:10.1136/bmj.f6867). (PMID:24277339)

Record type: Article

Abstract

Objective: to document whether elements of a structured history and examination predict adverse outcome of acute sore throat.

Design: prospective clinical cohort.

Setting: primary care.

Participants: 610 adults with acute sore throat (?2 weeks’ duration).

Main outcome measures: common suppurative complications (quinsy or peritonsillar abscess, otitis media, sinusitis, impetigo or cellulitis) and reconsultation with new or unresolving symptoms within one month.

Results: complications were assessed reliably (inter-rater ?=0.95). 1.3% (177/13<thin>445) of participants developed complications overall and 14.2% (1889/13<thin>288) reconsulted with new or unresolving symptoms. Independent predictors of complications were severe tonsillar inflammation (documented among 13.0% (1652/12<thin>717); odds ratio 1.92, 95% confidence interval 1.28 to 2.89) and severe earache (5% (667/13<thin>323); 3.02, 1.91 to 4.76), but the model including both variables had modest prognostic utility (bootstrapped area under the receiver operator curve 0.61, 0.57 to 0.65), and 70% of complications (124/177) occurred when neither was present. Clinical prediction rules for bacterial infection (Centor criteria and FeverPAIN) also predicted complications, but predictive values were also poor and most complications occurred with low scores (67% (118/175) scoring ?2 for Centor; 126/173 (73%) scoring ?2 for FeverPAIN). Previous medical problems, sex, temperature, and muscle aches were independently but weakly associated with reconsultation with new or unresolving symptoms.

Conclusion: important suppurative complications after an episode of acute sore throat in primary care are uncommon. History and examination and scores to predict bacterial infection cannot usefully identify those who will develop complications. Clinicians will need to rely on strategies such as safety netting or delayed prescription in managing the uncertainty and low risk of complications

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Accepted/In Press date: 4 November 2013
Published date: 25 November 2013
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 360073
URI: https://eprints.soton.ac.uk/id/eprint/360073
ISSN: 0959-8138
PURE UUID: c9c62a9f-f017-4076-af47-cd3d89c19662
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 25 Nov 2013 09:34
Last modified: 18 Jul 2019 01:05

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Contributors

Author: Paul Little
Author: Beth Stuart
Author: F.D. Richard Hobbs
Author: Chris C. Butler
Author: Alastair D. Hay
Author: John Campbell
Author: Brendan Delaney
Author: Sue Broomfield
Author: Paula Barratt
Author: Karenza Hood
Author: Hazel Everitt ORCID iD
Author: Mark Mullee
Author: Ian Williamson
Author: David Mant
Author: Michael Moore ORCID iD

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