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Predicting poor outcome in patients presenting to primary care with acute cough

Predicting poor outcome in patients presenting to primary care with acute cough
Predicting poor outcome in patients presenting to primary care with acute cough
Background. Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care.
Aim. We set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms or hospital admission) in adults presenting to primary care with acute cough
Design and setting. 2604 adults presenting to primary care with acute cough
Method. Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared to that of existing prediction rules, using the models’ area under the receiver operator characteristic curve (AUC), and improvement obtained by including additional test results (C-reactive protein (CRP), blood urea nitrogen (BUN), chest radiography or etiology) was evaluated using the same methodology.
Results. The new prediction rule included the baseline risk of poor outcome, interference with daily activities, number of years stopped smoking (above or below 45 years), severity of sputum, presence of crackles and diastolic blood pressure (above or below 85 mmHg), and severity of sputum. Although performance of the new prediction rule was moderate (sensitivity 62%; specificity 59%; positive predictive value 27%; negative predictive value 86%; AUC 0.62 [0.61-0.67]), it outperformed all existing prediction rules used today (highest AUC 0.53 [0.51-0.56]) and could not be improved by including additional test results (highest AUC 0.64 [0.62-0.68]).
Conclusion. The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.
0960-1643
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bruyndonckx, Robin
f4de37c8-5255-4d22-936b-62a7c900c81a
Hens, Neil
ae31e0dd-2c9b-47b7-91b8-814f44ea6de8
Aerts, Marc
2fe1344f-69b0-442d-b4ab-cc5811775e3a
Ieven, M
c138048d-d838-4c8e-848d-a43e309f4cf0
Butler, Christopher
8bf4cace-c34a-4b65-838f-29c2be91e434
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Bruyndonckx, Robin
f4de37c8-5255-4d22-936b-62a7c900c81a
Hens, Neil
ae31e0dd-2c9b-47b7-91b8-814f44ea6de8
Aerts, Marc
2fe1344f-69b0-442d-b4ab-cc5811775e3a
Ieven, M
c138048d-d838-4c8e-848d-a43e309f4cf0
Butler, Christopher
8bf4cace-c34a-4b65-838f-29c2be91e434
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e

Little, Paul, Bruyndonckx, Robin, Hens, Neil, Aerts, Marc, Ieven, M, Butler, Christopher, Goossens, Herman and Coenen, Samuel (2018) Predicting poor outcome in patients presenting to primary care with acute cough. British Journal of General Practice. (In Press)

Record type: Article

Abstract

Background. Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care.
Aim. We set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms or hospital admission) in adults presenting to primary care with acute cough
Design and setting. 2604 adults presenting to primary care with acute cough
Method. Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared to that of existing prediction rules, using the models’ area under the receiver operator characteristic curve (AUC), and improvement obtained by including additional test results (C-reactive protein (CRP), blood urea nitrogen (BUN), chest radiography or etiology) was evaluated using the same methodology.
Results. The new prediction rule included the baseline risk of poor outcome, interference with daily activities, number of years stopped smoking (above or below 45 years), severity of sputum, presence of crackles and diastolic blood pressure (above or below 85 mmHg), and severity of sputum. Although performance of the new prediction rule was moderate (sensitivity 62%; specificity 59%; positive predictive value 27%; negative predictive value 86%; AUC 0.62 [0.61-0.67]), it outperformed all existing prediction rules used today (highest AUC 0.53 [0.51-0.56]) and could not be improved by including additional test results (highest AUC 0.64 [0.62-0.68]).
Conclusion. The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.

Text Prognosis_paper_GRACE_22_12_17 - Author's Original
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Accepted/In Press date: 2 January 2018

Identifiers

Local EPrints ID: 416844
URI: https://eprints.soton.ac.uk/id/eprint/416844
ISSN: 0960-1643
PURE UUID: 244ebf2b-71d1-49a9-8b8e-51a95ff0005c

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Date deposited: 11 Jan 2018 17:30
Last modified: 11 Jan 2018 17:30

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Contributors

Author: Paul Little
Author: Robin Bruyndonckx
Author: Neil Hens
Author: Marc Aerts
Author: M Ieven
Author: Christopher Butler
Author: Herman Goossens
Author: Samuel Coenen

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