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Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data

Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data
Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data
Background: there is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration.

Aim: to describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories.

Design and setting: the study included data about 9103 adults and children from 12 primary care studies.

Method: a latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed.

Results: in total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: ‘rapid (6 days)’ (90% of participants recovered within 6 days) in 52.0%; ‘intermediate (10 days)’ (28.9%); ‘slow progressive improvement (27 days)’ (12.5%); and ‘slow improvement with initial high symptom burden (27 days)’ (6.6%). For cough, being aged 16–64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with <16 years), higher presenting illness baseline severity (OR 1.51, 95% CI = 1.12 to 2.03), presence of lung disease (OR 1.78, 95% CI = 1.44 to 2.21), and median and above illness duration before consultation (≥7 days) (OR 1.99, 95% CI = 1.68 to 2.37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively).

Conclusion: older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.
antibiotics, general practice, latent class analysis, respiratory tract infections
0960-1643
E196-E203
Hounkpatin, Hilda
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Stuart, Beth
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Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Yao, Guiqing Lily
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Moore, Michael
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Loffler, Christin
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Little, Paul
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Kenealy, Timothy
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Gillespie, David
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Francis, N.A.
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Bostock, Jennifer
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Becque, Taeko
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Arroll, Bruce
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Altiner, Attila
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Alonso-Coello, Pablo
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Hay, Alastair D.
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Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Stuart, Beth
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Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Yao, Guiqing Lily
93c8b843-35ee-4a63-8486-98efa85cb7f5
Moore, Michael
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Loffler, Christin
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Little, Paul
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Kenealy, Timothy
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Gillespie, David
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Francis, N.A.
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Bostock, Jennifer
3a741e2f-f94c-4112-bfdc-42216867a40b
Becque, Taeko
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Arroll, Bruce
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Altiner, Attila
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Alonso-Coello, Pablo
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Hay, Alastair D.
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Hounkpatin, Hilda, Stuart, Beth, Zhu, Shihua, Yao, Guiqing Lily, Moore, Michael, Loffler, Christin, Little, Paul, Kenealy, Timothy, Gillespie, David, Francis, N.A., Bostock, Jennifer, Becque, Taeko, Arroll, Bruce, Altiner, Attila, Alonso-Coello, Pablo and Hay, Alastair D. (2023) Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data. British Journal of General Practice, 73 (728), E196-E203. (doi:10.3399/BJGP.2022.0229).

Record type: Article

Abstract

Background: there is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration.

Aim: to describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories.

Design and setting: the study included data about 9103 adults and children from 12 primary care studies.

Method: a latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed.

Results: in total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: ‘rapid (6 days)’ (90% of participants recovered within 6 days) in 52.0%; ‘intermediate (10 days)’ (28.9%); ‘slow progressive improvement (27 days)’ (12.5%); and ‘slow improvement with initial high symptom burden (27 days)’ (6.6%). For cough, being aged 16–64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with <16 years), higher presenting illness baseline severity (OR 1.51, 95% CI = 1.12 to 2.03), presence of lung disease (OR 1.78, 95% CI = 1.44 to 2.21), and median and above illness duration before consultation (≥7 days) (OR 1.99, 95% CI = 1.68 to 2.37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively).

Conclusion: older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.

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e-pub ahead of print date: 1 March 2023
Published date: 1 March 2023
Additional Information: Funding Information: This work was funded by the National Institute for Health and Care Research (NIHR) Research for Patient Benefit (RfPB) Programme (grant number: PB-PG-0416–20005). This funding supported the collation of the individual participant data, data management, and analyses. The NIHR RfPB was not involved in any other aspect of the project, such as the design of the project’s protocol and analysis plan, the collection, and analyses. The funder had no input on the interpretation or publication of the study results. Publisher Copyright: ©The Authors.
Keywords: antibiotics, general practice, latent class analysis, respiratory tract infections

Identifiers

Local EPrints ID: 475211
URI: http://eprints.soton.ac.uk/id/eprint/475211
ISSN: 0960-1643
PURE UUID: f2542d82-b59a-4b9e-aeb0-69eb36ee1b8e
ORCID for Hilda Hounkpatin: ORCID iD orcid.org/0000-0002-1360-1791
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873
ORCID for N.A. Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Taeko Becque: ORCID iD orcid.org/0000-0002-0362-3794

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Date deposited: 14 Mar 2023 17:38
Last modified: 12 Jul 2024 02:05

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Contributors

Author: Beth Stuart ORCID iD
Author: Shihua Zhu
Author: Guiqing Lily Yao
Author: Michael Moore ORCID iD
Author: Christin Loffler
Author: Paul Little ORCID iD
Author: Timothy Kenealy
Author: David Gillespie
Author: N.A. Francis ORCID iD
Author: Jennifer Bostock
Author: Taeko Becque ORCID iD
Author: Bruce Arroll
Author: Attila Altiner
Author: Pablo Alonso-Coello
Author: Alastair D. Hay

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