Predicting illness progression for children with lower respiratory infections in primary care: a prospective cohort and observational study
Predicting illness progression for children with lower respiratory infections in primary care: a prospective cohort and observational study
Background Antibiotics are commonly prescribed for children with lower respiratory tract infections (LRTIs), fuelling antibiotic resistance, and there are few prognostic tools available to inform management. Aim To externally validate an existing prognostic model (STARWAVe) to identify children at low risk of illness progression, and if model performance was limited to develop a new internally validated prognostic model. Design and setting Prospective cohort study with a nested trial in a primary care setting. Method Children aged 6 months to 12 years presenting with uncomplicated LRTI were included in the cohort. Children were randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or if not randomised they participated in a parallel observational study to maximise generalisability. Baseline clinical data were used to predict adverse outcome (illness progression requiring hospital assessment). Results A total of 758 children participated (n= 432 trial, n= 326 observational). For predicting illness progression the STARWAVe prognostic model had moderate performance (area under the receiver operating characteristic [AUROC] 0.66, 95% confidence interval [CI] = 0.50 to 0.77), but a new, internally validated model (seven items: baseline severity; respiratory rate; duration of prior illness; oxygen saturation; sputum or a rattly chest; passing urine less often; and diarrhoea) had good discrimination (bootstrapped AUROC 0.83, 95% CI = 0.74 to 0.92) and calibration. A three-item model (respiratory rate; oxygen saturation; and sputum or a rattly chest) also performed well (AUROC 0.81, 95% CI = 0.70 to 0.91), as did a score (ranging from 19 to 102) derived from coefficients of the model (AUROC 0.78, 95% CI = 0.67 to 0.88): a score of <70 classified 89% (n= 600/674) of children having a low risk (<5%) of progression of illness. Conclusion A simple three-item prognostic score could be useful as a tool to identify children with LRTI who are at low risk of an adverse outcome and to guide clinical management.
Amoxicillin/therapeutic use, Anti-Bacterial Agents/therapeutic use, Child, Humans, Primary Health Care, Prospective Studies, Respiratory Tract Infections/diagnosis, respiratory tract infections, antibiotic resistance, children, primary health care, antibiotics
e885-e893
Little, Paul
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Becque, Taeko
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Hay, Alastair D.
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Francis, Nick A.
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Stuart, Beth
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O'Reilly, Gilly
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Thompson, Natalie
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Hood, Kerenza
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Moore, Michael
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Verheij, Theo
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2023
Little, Paul
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Becque, Taeko
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Hay, Alastair D.
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Francis, Nick A.
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Stuart, Beth
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O'Reilly, Gilly
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Thompson, Natalie
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Hood, Kerenza
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Moore, Michael
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Verheij, Theo
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Little, Paul, Becque, Taeko, Hay, Alastair D., Francis, Nick A., Stuart, Beth, O'Reilly, Gilly, Thompson, Natalie, Hood, Kerenza, Moore, Michael and Verheij, Theo
(2023)
Predicting illness progression for children with lower respiratory infections in primary care: a prospective cohort and observational study.
The British journal of general practice : the journal of the Royal College of General Practitioners, 73 (737), .
(doi:10.3399/BJGP.2022.0493).
Abstract
Background Antibiotics are commonly prescribed for children with lower respiratory tract infections (LRTIs), fuelling antibiotic resistance, and there are few prognostic tools available to inform management. Aim To externally validate an existing prognostic model (STARWAVe) to identify children at low risk of illness progression, and if model performance was limited to develop a new internally validated prognostic model. Design and setting Prospective cohort study with a nested trial in a primary care setting. Method Children aged 6 months to 12 years presenting with uncomplicated LRTI were included in the cohort. Children were randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or if not randomised they participated in a parallel observational study to maximise generalisability. Baseline clinical data were used to predict adverse outcome (illness progression requiring hospital assessment). Results A total of 758 children participated (n= 432 trial, n= 326 observational). For predicting illness progression the STARWAVe prognostic model had moderate performance (area under the receiver operating characteristic [AUROC] 0.66, 95% confidence interval [CI] = 0.50 to 0.77), but a new, internally validated model (seven items: baseline severity; respiratory rate; duration of prior illness; oxygen saturation; sputum or a rattly chest; passing urine less often; and diarrhoea) had good discrimination (bootstrapped AUROC 0.83, 95% CI = 0.74 to 0.92) and calibration. A three-item model (respiratory rate; oxygen saturation; and sputum or a rattly chest) also performed well (AUROC 0.81, 95% CI = 0.70 to 0.91), as did a score (ranging from 19 to 102) derived from coefficients of the model (AUROC 0.78, 95% CI = 0.67 to 0.88): a score of <70 classified 89% (n= 600/674) of children having a low risk (<5%) of progression of illness. Conclusion A simple three-item prognostic score could be useful as a tool to identify children with LRTI who are at low risk of an adverse outcome and to guide clinical management.
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Accepted/In Press date: 12 May 2023
e-pub ahead of print date: 30 November 2023
Published date: 2023
Additional Information:
Funding Information:
This project is funded by the Health Technology Assessment(HTA) Programme (studyreference:13/34/64) of the National Institute for Health and Care Research (NIHR). The views expressed in this publication are those of the author sandnot necessarily those of the HTA, NHS, NIHR, or the Department of Health and Social Care. The authors are very grateful to both the trial steering committee (Chair Elaine Hay) and the data safety monitoring committee (Chair Sally Kerry) for their support and advice.
Funding Information:
This project is funded by the Health Technology Assessment (HTA) Programme (study reference: 13/34/64) of the National Institute for Health and Care Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the HTA, NHS, NIHR, or the Department of Health and Social Care.
Funding Information:
Theo Verheij reports grants from the European Union and The Netherlands Organization of Health Research and Development during the conduct of the study; and grants from Abbott, Becton Dickinson, Bio-Merieux, and Janssen Pharmaceuticals outside the submitted work. The other authors have declared no competing interests (other than the grant support from the NIHR for the submitted work).
Publisher Copyright:
©The Authors.
Keywords:
Amoxicillin/therapeutic use, Anti-Bacterial Agents/therapeutic use, Child, Humans, Primary Health Care, Prospective Studies, Respiratory Tract Infections/diagnosis, respiratory tract infections, antibiotic resistance, children, primary health care, antibiotics
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Local EPrints ID: 485684
URI: http://eprints.soton.ac.uk/id/eprint/485684
ISSN: 0960-1643
PURE UUID: 95ec2d3b-c263-4b40-b137-51d6ed87ccd3
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Date deposited: 14 Dec 2023 17:36
Last modified: 18 Mar 2024 03:54
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Contributors
Author:
Alastair D. Hay
Author:
Gilly O'Reilly
Author:
Natalie Thompson
Author:
Kerenza Hood
Author:
Theo Verheij
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