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

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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:BackgroundAir pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development.Methods and findingsWe conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10-700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home. Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%-8.8%] versus 11.5% [95% CI 8.9%-12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%-23.1%). Residual confounding for social class could not be discarded completely; however, the associations remained in stratified analyses (e.g., for type of school or high-/low-polluted area) and after additional adjustments (e.g., for commuting, educational quality, or smoking at home), contradicting a potential residual confounding explanation.ConclusionsChildren attending schools with higher traffic-related air pollution had a smaller improvement in cognitive development.

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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