RT Journal Article
SR Electronic
T1 Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 231
OP 238
DO 10.1370/afm.2386
VO 17
IS 3
A1 Michael Moore
A1 Beth Stuart
A1 Mark Lown
A1 Ann Van den Bruel
A1 Sue Smith
A1 Kyle Knox
A1 Matthew J. Thompson
A1 Paul Little
YR 2019
UL http://www.annfammed.org/content/17/3/231.abstract
AB 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.