What gives rise to clinician gut feeling, its influence on management decisions and its prognostic value for children with RTI in primary care: A prospective cohort study
What gives rise to clinician gut feeling, its influence on management decisions and its prognostic value for children with RTI in primary care: A prospective cohort study
Background: The objectives were to identify 1) the clinician and child characteristics associated with; 2) clinical management decisions following from, and; 3) the prognostic value of; a clinician's 'gut feeling something is wrong' for children presenting to primary care with acute cough and respiratory tract infection (RTI).
Methods: Multicentre prospective cohort study where 518 primary care clinicians across 244 general practices in England assessed 8394 children aged ≥3 months and < 16 years for acute cough and RTI. The main outcome measures were: Self-reported clinician 'gut feeling'; clinician management decisions (antibiotic prescribing, referral for acute admission); and child's prognosis (reconsultation with evidence of illness deterioration, hospital admission in the 30 days following recruitment).
Results: Clinician years since qualification, parent reported symptoms (illness severity score ≥ 7/10, severe fever < 24 h, low energy, shortness of breath) and clinical examination findings (crackles/ crepitations on chest auscultation, recession, pallor, bronchial breathing, wheeze, temperature ≥ 37.8 °C, tachypnoea and inflamed pharynx) independently contributed towards a clinician 'gut feeling that something was wrong'. 'Gut feeling' was independently associated with increased antibiotic prescribing and referral for secondary care assessment. After adjustment for other associated factors, gut feeling was not associated with reconsultations or hospital admissions.
Conclusions: Clinicians were more likely to report a gut feeling something is wrong, when they were more experienced or when children were more unwell. Gut feeling is independently and strongly associated with antibiotic prescribing and referral to secondary care, but not with two indicators of poor child health.
Child, Cough, Decision making, Emotions, Paediatric, Primary health care, Prognosis, Respiratory tract infections
Turnbull, Sophie
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Lucas, Patricia J.
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Redmond, Niamh M.
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Christensen, Hannah
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Thornton, Hannah
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Cabral, Christie
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Blair, Peter S.
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Delaney, Brendan C.
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Thompson, Matthew
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Little, Paul
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Peters, Tim J.
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Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Turnbull, Sophie
135b4809-1046-4b61-803d-b8baeecefc6c
Lucas, Patricia J.
1d64fb4f-1f3c-4337-bab2-03c98d24bf79
Redmond, Niamh M.
dbb0bc92-e3df-47e4-ad16-f392d8f8a8aa
Christensen, Hannah
40b98873-db4c-492e-86c8-cad5f6b4630b
Thornton, Hannah
fa5337a1-502a-4904-a8b4-2f0687c8634e
Cabral, Christie
e45df99c-4e9a-4d55-b9f0-923ee4b2a506
Blair, Peter S.
3d5e258e-a342-4f3f-98a3-195267ee7456
Delaney, Brendan C.
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Thompson, Matthew
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Little, Paul
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Peters, Tim J.
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Hay, Alastair D.
bfae9e44-ae9b-473c-923f-1dea50747023
Turnbull, Sophie, Lucas, Patricia J., Redmond, Niamh M., Christensen, Hannah, Thornton, Hannah, Cabral, Christie, Blair, Peter S., Delaney, Brendan C., Thompson, Matthew, Little, Paul, Peters, Tim J. and Hay, Alastair D.
(2018)
What gives rise to clinician gut feeling, its influence on management decisions and its prognostic value for children with RTI in primary care: A prospective cohort study.
BMC Family Practice, 19 (1), [25].
(doi:10.1186/s12875-018-0716-7).
Abstract
Background: The objectives were to identify 1) the clinician and child characteristics associated with; 2) clinical management decisions following from, and; 3) the prognostic value of; a clinician's 'gut feeling something is wrong' for children presenting to primary care with acute cough and respiratory tract infection (RTI).
Methods: Multicentre prospective cohort study where 518 primary care clinicians across 244 general practices in England assessed 8394 children aged ≥3 months and < 16 years for acute cough and RTI. The main outcome measures were: Self-reported clinician 'gut feeling'; clinician management decisions (antibiotic prescribing, referral for acute admission); and child's prognosis (reconsultation with evidence of illness deterioration, hospital admission in the 30 days following recruitment).
Results: Clinician years since qualification, parent reported symptoms (illness severity score ≥ 7/10, severe fever < 24 h, low energy, shortness of breath) and clinical examination findings (crackles/ crepitations on chest auscultation, recession, pallor, bronchial breathing, wheeze, temperature ≥ 37.8 °C, tachypnoea and inflamed pharynx) independently contributed towards a clinician 'gut feeling that something was wrong'. 'Gut feeling' was independently associated with increased antibiotic prescribing and referral for secondary care assessment. After adjustment for other associated factors, gut feeling was not associated with reconsultations or hospital admissions.
Conclusions: Clinicians were more likely to report a gut feeling something is wrong, when they were more experienced or when children were more unwell. Gut feeling is independently and strongly associated with antibiotic prescribing and referral to secondary care, but not with two indicators of poor child health.
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Accepted/In Press date: 24 January 2018
e-pub ahead of print date: 5 February 2018
Keywords:
Child, Cough, Decision making, Emotions, Paediatric, Primary health care, Prognosis, Respiratory tract infections
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Local EPrints ID: 418125
URI: http://eprints.soton.ac.uk/id/eprint/418125
ISSN: 1471-2296
PURE UUID: cde7827c-ec9a-4a79-88c3-bf8323367326
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Date deposited: 22 Feb 2018 17:30
Last modified: 12 Jul 2024 01:34
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Contributors
Author:
Sophie Turnbull
Author:
Patricia J. Lucas
Author:
Niamh M. Redmond
Author:
Hannah Christensen
Author:
Hannah Thornton
Author:
Christie Cabral
Author:
Peter S. Blair
Author:
Brendan C. Delaney
Author:
Matthew Thompson
Author:
Tim J. Peters
Author:
Alastair D. Hay
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