Dataset Information

Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

ABSTRACT:

Background

There is uncertainty about which children with cough are most and least likely to experience complications.

Aim

To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough.

Design of study

Prospective cohort study.

Setting

Eight general practices in Leicestershire, United Kingdom.

Method

Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, clinical history, and examination data were collected and univariable logistic regression used to explore the associations with complications. These were defined as any new symptom, sign or diagnosis identified by a primary care clinician at a parent initiated reconsultation, or hospital admission, before cough resolution. Those factors with stronger relationships (P< 0.2) were then modelled using multivariable logistic regression to identify the factors independently associated with complications.

Results

The pre-test probability of complications was 10%. On univariable analysis, fever (odds ratio [OR] = 4.86; 95% confidence interval [CI] = 1.74 to 13.6), chest signs (OR = 2.72; CI = 1.06 to 6.96), and tachypnoea (OR = 3.80; CI = 1.22 to 11.8) were associated with complications. On multivariable analysis, only fever (OR = 5.56; CI = 1.75 to 17.6) and chest signs (OR = 2.88; CI = 1.02 to 8.05) were independently associated with complications. These ORs translate into post-test probabilities of complications of 6% for children with neither fever nor chest signs, 18% for children with chest signs, 28% for children with fever, and 40% for children with fever and chest signs.

Conclusions

If validated, this clinical prediction rule could be used to individualise the management of acute cough in pre-school children.

SUBMITTER: Hay AD

PROVIDER: S-EPMC1314771 | biostudies-literature | 2004 Jan

REPOSITORIES: biostudies-literature

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Publications

Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

Hay Alastair D AD Fahey Tom T Peters Tim J TJ Wilson Andrew A

The British journal of general practice : the journal of the Royal College of General Practitioners 20040101 498

<h4>Background</h4>There is uncertainty about which children with cough are most and least likely to experience complications.<h4>Aim</h4>To derive a clinical prediction rule for complications in pre-school children presenting to primary care with acute cough.<h4>Design of study</h4>Prospective cohort study.<h4>Setting</h4>Eight general practices in Leicestershire, United Kingdom.<h4>Method</h4>Pre-school children with cough for < or =28 days and without asthma were recruited. Sociodemographic, ...[more]

PMID: 14965400

Similar Datasets

Project description:BackgroundFew clinical rules have been derived let alone validated in primary care. A rule was derived to predict complications of acute cough in preschool children presenting to primary care. The clinical rule used the presence/absence of fever and/or chest signs to distinguish children at low, medium, and high risk of complications.AimTo validate a clinical rule for predicting complications of acute cough in preschool children in primary care.Design of studyProspective cohort study.SettingThirteen general practices in Bristol and Tayside, UK.MethodPreschool children with cough up to 28 days and without asthma were recruited. The same sociodemographic, clinical history, examination, and complications data as for the derivation study were collected. First, univariable logistic regression was used to explore the associations with complications, and then predictors with stronger relationships (P<0.2) were modelled using multivariable logistic regression. These predictors were compared with derivation predictors with respect to their strength of association with complications. The derivation predictors were used in the validation dataset to allow comparison of the post-test probabilities of complications between derivation and validation studies.ResultsThe presence of fever and chest signs in the validation study tended to be protective for complications, with univariable odds ratios (ORs) of 0.37 and 0.81 respectively, compared with ORs of 4.86 and 2.72 in the derivation study. However, 95% confidence limits were wide and evidence for two other possible reasons for these results were found: spectrum bias and confounding by indication.ConclusionNo evidence was found to validate the clinical rule for predicting complications of acute cough, possibly as a result of spectrum bias, confounding by indication, and/or chance. As paediatric infectious illness is costly and associated with high rates of antibiotic use, further research is needed to derive and validate prediction rules.

Project description:ObjectiveChildren with special health care needs (SHCN) due to a chronic health condition perform more poorly at school compared to their classmates. There is still little knowledge on the causal pathways and which factors could be targeted by interventions. We, therefore, investigated school absenteeism in children with SHCN compared to their peers.MethodsThis study was based on data from the German population-based prospective cohort study ikidS (German for: I will start school). Children with SHCN were identified by the Children with Special Health Care Needs screener that captures five consequences of physical or mental chronic health conditions: (1) use or need of prescription medication, (2) above average use or need of medical, mental health, or educational services, (3) functional limitations compared with others of the same age, (4) use or need of specialized therapies, and (5) treatment or counseling for emotional, behavioral, or developmental problems. School absenteeism was defined as days absent from school due to illness during first grade and was reported by classroom teachers. Associations between SHCN consequences and school absenteeism were investigated by negative binomial regression models. Effect estimates were adjusted for confounding variables identified by a causal framework and directed acyclic graphs.Results1,921 children (mean age at follow-up 7.3 years, standard deviation 0.3; 49% females) were included; of these, 14% had SHCN. Compared to their classmates, children with SHCN had more days absent (adjusted rate ratio: 1.37; 95% confidence interval 1.16, 1.62). The effect was strongest among children with i) functional limitations, ii) treatment or counseling for emotional, behavioral, or developmental problems, and iii) those who experienced two or more SHCN consequences.ConclusionsChildren with SHCN have higher school absenteeism, which could-at least partly-explain their poorer school performance and lower educational attainment. SHCN-specific targeted interventions may reduce the adverse effects of SHCN on educational outcomes in children.

Dataset Information

Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

Background

Aim

Design of study

Setting

Method

Results

Conclusions

Publications

Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study.

Similar Datasets

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