Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections
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 pneumon...
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| Veröffentlicht in: | Annals of family medicine 2019-05, Vol.17 (3), p.231-238 |
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| creator | Moore, Michael, BMBS, FRCGP Stuart, Beth, PhD Lown, Mark, MBBS, PhD Van den Bruel, Ann, MD, PhD Smith, Sue, PhD Knox, Kyle, MBChB, MRCGP, MRCP Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP Little, Paul, MBBS, FRCGP |
| description | 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 |
| doi_str_mv | 10.1370/afm.2386 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6827627</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A628846280</galeid><els_id>1_s2_0_S1544170919301301</els_id><sourcerecordid>A628846280</sourcerecordid><originalsourceid>FETCH-LOGICAL-c563t-c60493040c04835437bf759ab32550e64ef741cc63e983570e8f34d8969819943</originalsourceid><addsrcrecordid>eNptkl1r2zAUhs3YWLtusF8wDIOyG2f6siXfDELZRyHQ0bXXQpGPEnWylEl2Rv795DXLGggS0kF6zhF6z1sUbzGaYcrRR2X6GaGieVac45qxCnPMnx9i1J4Vr1J6QIhgQsnL4oxiJOqa8PPi9nuEzuohxFQGU867LcQE5c046NBDKq0v730ON85qNUBXLsJviOUtpI2NKqftyruo9FBeewN6sMGn18ULo1yCN_v9orj_8vnu6lu1uPl6fTVfVLpu6FDpBrGWIoY0YoLWjPKl4XWrlpTUNYKGgeEMa91QaPM9RyAMZZ1om1bgtmX0ovj0WHczLnvoNPghKic30fYq7mRQVh7feLuWq7CVjSC8ITwX-LAvEMOvEdIge5s0OKc8hDFJksXKkjGCMvr-EV0pB9J6E3JFPeFy3hAhWF4mqjpBrcBDfj54MDYfH_GzE3weHfRWn0y4fJKwBuWGdQpu_Kv7Mbj_mo4hpQjmIAtGcrKMzJaRk2Uy-u6pjAfwn0f-6wy5mVsLUWpnfbaD-wk7SA9hjD73WWKZiETyx-S6yXQ4dxdP8w_hXc39</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2232021420</pqid></control><display><type>article</type><title>Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Moore, Michael, BMBS, FRCGP ; Stuart, Beth, PhD ; Lown, Mark, MBBS, PhD ; Van den Bruel, Ann, MD, PhD ; Smith, Sue, PhD ; Knox, Kyle, MBChB, MRCGP, MRCP ; Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP ; Little, Paul, MBBS, FRCGP</creator><creatorcontrib>Moore, Michael, BMBS, FRCGP ; Stuart, Beth, PhD ; Lown, Mark, MBBS, PhD ; Van den Bruel, Ann, MD, PhD ; Smith, Sue, PhD ; Knox, Kyle, MBChB, MRCGP, MRCP ; Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP ; Little, Paul, MBBS, FRCGP</creatorcontrib><description>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.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.2386</identifier><identifier>PMID: 31085527</identifier><language>eng</language><publisher>United States: Annals of Family Medicine</publisher><subject>Adult ; Bronchitis - complications ; Bronchitis - epidemiology ; Bronchitis - physiopathology ; Complications and side effects ; Development and progression ; Diagnosis ; Family Medicine/General Medicine ; Female ; Hospitalization - statistics & numerical data ; Humans ; Internal Medicine ; Male ; Middle Aged ; Original Research ; Outcome Assessment, Health Care - statistics & numerical data ; Pneumonia - epidemiology ; Pneumonia - etiology ; Practice Patterns, Physicians ; Primary Health Care - statistics & numerical data ; Prognosis ; Prospective Studies ; Respiratory tract infections ; Risk Assessment - methods ; Risk factors ; Sensitivity and Specificity ; Severity of Illness Index</subject><ispartof>Annals of family medicine, 2019-05, Vol.17 (3), p.231-238</ispartof><rights>Annals of Family Medicine, Inc.</rights><rights>2019 Annals of Family Medicine, Inc.</rights><rights>COPYRIGHT 2019 Annals of Family Medicine</rights><rights>2019 Annals of Family Medicine, Inc. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c563t-c60493040c04835437bf759ab32550e64ef741cc63e983570e8f34d8969819943</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827627/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827627/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31085527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moore, Michael, BMBS, FRCGP</creatorcontrib><creatorcontrib>Stuart, Beth, PhD</creatorcontrib><creatorcontrib>Lown, Mark, MBBS, PhD</creatorcontrib><creatorcontrib>Van den Bruel, Ann, MD, PhD</creatorcontrib><creatorcontrib>Smith, Sue, PhD</creatorcontrib><creatorcontrib>Knox, Kyle, MBChB, MRCGP, MRCP</creatorcontrib><creatorcontrib>Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP</creatorcontrib><creatorcontrib>Little, Paul, MBBS, FRCGP</creatorcontrib><title>Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>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.</description><subject>Adult</subject><subject>Bronchitis - complications</subject><subject>Bronchitis - epidemiology</subject><subject>Bronchitis - physiopathology</subject><subject>Complications and side effects</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Family Medicine/General Medicine</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Research</subject><subject>Outcome Assessment, Health Care - statistics & numerical data</subject><subject>Pneumonia - epidemiology</subject><subject>Pneumonia - etiology</subject><subject>Practice Patterns, Physicians</subject><subject>Primary Health Care - statistics & numerical data</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Respiratory tract infections</subject><subject>Risk Assessment - methods</subject><subject>Risk factors</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkl1r2zAUhs3YWLtusF8wDIOyG2f6siXfDELZRyHQ0bXXQpGPEnWylEl2Rv795DXLGggS0kF6zhF6z1sUbzGaYcrRR2X6GaGieVac45qxCnPMnx9i1J4Vr1J6QIhgQsnL4oxiJOqa8PPi9nuEzuohxFQGU867LcQE5c046NBDKq0v730ON85qNUBXLsJviOUtpI2NKqftyruo9FBeewN6sMGn18ULo1yCN_v9orj_8vnu6lu1uPl6fTVfVLpu6FDpBrGWIoY0YoLWjPKl4XWrlpTUNYKGgeEMa91QaPM9RyAMZZ1om1bgtmX0ovj0WHczLnvoNPghKic30fYq7mRQVh7feLuWq7CVjSC8ITwX-LAvEMOvEdIge5s0OKc8hDFJksXKkjGCMvr-EV0pB9J6E3JFPeFy3hAhWF4mqjpBrcBDfj54MDYfH_GzE3weHfRWn0y4fJKwBuWGdQpu_Kv7Mbj_mo4hpQjmIAtGcrKMzJaRk2Uy-u6pjAfwn0f-6wy5mVsLUWpnfbaD-wk7SA9hjD73WWKZiETyx-S6yXQ4dxdP8w_hXc39</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Moore, Michael, BMBS, FRCGP</creator><creator>Stuart, Beth, PhD</creator><creator>Lown, Mark, MBBS, PhD</creator><creator>Van den Bruel, Ann, MD, PhD</creator><creator>Smith, Sue, PhD</creator><creator>Knox, Kyle, MBChB, MRCGP, MRCP</creator><creator>Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP</creator><creator>Little, Paul, MBBS, FRCGP</creator><general>Annals of Family Medicine</general><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190501</creationdate><title>Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections</title><author>Moore, Michael, BMBS, FRCGP ; Stuart, Beth, PhD ; Lown, Mark, MBBS, PhD ; Van den Bruel, Ann, MD, PhD ; Smith, Sue, PhD ; Knox, Kyle, MBChB, MRCGP, MRCP ; Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP ; Little, Paul, MBBS, FRCGP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c563t-c60493040c04835437bf759ab32550e64ef741cc63e983570e8f34d8969819943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Bronchitis - complications</topic><topic>Bronchitis - epidemiology</topic><topic>Bronchitis - physiopathology</topic><topic>Complications and side effects</topic><topic>Development and progression</topic><topic>Diagnosis</topic><topic>Family Medicine/General Medicine</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Research</topic><topic>Outcome Assessment, Health Care - statistics & numerical data</topic><topic>Pneumonia - epidemiology</topic><topic>Pneumonia - etiology</topic><topic>Practice Patterns, Physicians</topic><topic>Primary Health Care - statistics & numerical data</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Respiratory tract infections</topic><topic>Risk Assessment - methods</topic><topic>Risk factors</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, Michael, BMBS, FRCGP</creatorcontrib><creatorcontrib>Stuart, Beth, PhD</creatorcontrib><creatorcontrib>Lown, Mark, MBBS, PhD</creatorcontrib><creatorcontrib>Van den Bruel, Ann, MD, PhD</creatorcontrib><creatorcontrib>Smith, Sue, PhD</creatorcontrib><creatorcontrib>Knox, Kyle, MBChB, MRCGP, MRCP</creatorcontrib><creatorcontrib>Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP</creatorcontrib><creatorcontrib>Little, Paul, MBBS, FRCGP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, Michael, BMBS, FRCGP</au><au>Stuart, Beth, PhD</au><au>Lown, Mark, MBBS, PhD</au><au>Van den Bruel, Ann, MD, PhD</au><au>Smith, Sue, PhD</au><au>Knox, Kyle, MBChB, MRCGP, MRCP</au><au>Thompson, Matthew J., MBChB, MPH, DPhil, MRCGP</au><au>Little, Paul, MBBS, FRCGP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>17</volume><issue>3</issue><spage>231</spage><epage>238</epage><pages>231-238</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><abstract>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.</abstract><cop>United States</cop><pub>Annals of Family Medicine</pub><pmid>31085527</pmid><doi>10.1370/afm.2386</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Bronchitis - complications Bronchitis - epidemiology Bronchitis - physiopathology Complications and side effects Development and progression Diagnosis Family Medicine/General Medicine Female Hospitalization - statistics & numerical data Humans Internal Medicine Male Middle Aged Original Research Outcome Assessment, Health Care - statistics & numerical data Pneumonia - epidemiology Pneumonia - etiology Practice Patterns, Physicians Primary Health Care - statistics & numerical data Prognosis Prospective Studies Respiratory tract infections Risk Assessment - methods Risk factors Sensitivity and Specificity Severity of Illness Index |
| title | Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections |
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