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Predictors of adverse outcomes in uncomplicated lower respiratory tract infections

Predictors of adverse outcomes in uncomplicated lower respiratory tract infections
Predictors of adverse outcomes in uncomplicated lower respiratory tract infections

PURPOSE: Presentation with acute lower respiratory tract infection (LRTI) in primary care is common. The aim of this study was to help clinicians treat patients presenting with LRTI in primary care by identifying those at risk of serious adverse outcomes (death, admission, late-onset pneumonia). METHODS: In a prospective cohort study of patients presenting with LRTI symptoms, patient characteristics and clinical findings were recorded and adverse events identified over 30 days by chart review. Multivariable logistic regression analyses identified predictors of adverse outcomes. RESULTS: Participants were recruited from 522 UK practices in 2009-2013. The analysis was restricted to the 28,846 adult patients not referred immediately to the hospital. Serious adverse outcomes occurred in 325/28,846 (1.1%). Eight factors were independently predictive; these characterized symptom severity (absence of coryza, fever, chest pain, and clinician-assessed severity), patient vulnerability (age >65 years, comorbidity), and physiological impact (oxygen saturation <95%, low blood pressure). In aggregate, the 8 features had moderate predictive value (area under the receiver operating characteristic curve 0.71, 95% CI, 0.68-0.74); the 4% of patients with ≥5 features had an approximately 1 in 17 (5.7%) risk of serious adverse outcomes, the 35% with 3 or 4 features had an intermediate risk (1 in 50, 2.0%), and the 61% with ≤2 features had a low (1 in 200, 0.5%) risk. CONCLUSIONS: In routine practice most patients presenting with LRTI in primary care can be identified as at intermediate or low risk of serious outcome.

decision support techniques, primary health care, prognosis, respiratory tract infections
1544-1709
231-238
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Van den Bruel, Ann
bd3225c7-17d2-48f2-adfe-11d3dd337522
Smith, Sue
6679a4a5-f362-435f-a533-5e8e73c2af1f
Knox, Kyle
e3415c23-e33b-43e1-8791-2ce1f4d11aae
Thompson, Matthew J.
6c021dd1-e725-46a2-8b8f-f41bcfc0adfa
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Van den Bruel, Ann
bd3225c7-17d2-48f2-adfe-11d3dd337522
Smith, Sue
6679a4a5-f362-435f-a533-5e8e73c2af1f
Knox, Kyle
e3415c23-e33b-43e1-8791-2ce1f4d11aae
Thompson, Matthew J.
6c021dd1-e725-46a2-8b8f-f41bcfc0adfa
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Moore, Michael, Stuart, Beth, Lown, Mark, Van den Bruel, Ann, Smith, Sue, Knox, Kyle, Thompson, Matthew J. and Little, Paul (2019) Predictors of adverse outcomes in uncomplicated lower respiratory tract infections. Annals of Family Medicine, 17 (3), 231-238. (doi:10.1370/afm.2386).

Record type: Article

Abstract

PURPOSE: Presentation with acute lower respiratory tract infection (LRTI) in primary care is common. The aim of this study was to help clinicians treat patients presenting with LRTI in primary care by identifying those at risk of serious adverse outcomes (death, admission, late-onset pneumonia). METHODS: In a prospective cohort study of patients presenting with LRTI symptoms, patient characteristics and clinical findings were recorded and adverse events identified over 30 days by chart review. Multivariable logistic regression analyses identified predictors of adverse outcomes. RESULTS: Participants were recruited from 522 UK practices in 2009-2013. The analysis was restricted to the 28,846 adult patients not referred immediately to the hospital. Serious adverse outcomes occurred in 325/28,846 (1.1%). Eight factors were independently predictive; these characterized symptom severity (absence of coryza, fever, chest pain, and clinician-assessed severity), patient vulnerability (age >65 years, comorbidity), and physiological impact (oxygen saturation <95%, low blood pressure). In aggregate, the 8 features had moderate predictive value (area under the receiver operating characteristic curve 0.71, 95% CI, 0.68-0.74); the 4% of patients with ≥5 features had an approximately 1 in 17 (5.7%) risk of serious adverse outcomes, the 35% with 3 or 4 features had an intermediate risk (1 in 50, 2.0%), and the 61% with ≤2 features had a low (1 in 200, 0.5%) risk. CONCLUSIONS: In routine practice most patients presenting with LRTI in primary care can be identified as at intermediate or low risk of serious outcome.

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Adverse respiratory tract infections_Annals_revision_final - Accepted Manuscript
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Accepted/In Press date: 28 February 2019
Published date: 1 May 2019
Keywords: decision support techniques, primary health care, prognosis, respiratory tract infections

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Local EPrints ID: 431655
URI: http://eprints.soton.ac.uk/id/eprint/431655
ISSN: 1544-1709
PURE UUID: 53f4c18e-896d-41f2-9d65-e3b248c0ed80
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Mark Lown: ORCID iD orcid.org/0000-0001-8309-568X

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Date deposited: 12 Jun 2019 16:30
Last modified: 18 Feb 2021 17:25

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Contributors

Author: Michael Moore ORCID iD
Author: Beth Stuart ORCID iD
Author: Mark Lown ORCID iD
Author: Ann Van den Bruel
Author: Sue Smith
Author: Kyle Knox
Author: Matthew J. Thompson
Author: Paul Little

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