Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries

Bruyndonckx, Robin; Hens, Niel; Verheij, Theo; Aerts, Marc; Ieven, Margareta; Butler, Christopher Collett; Little, Paul; Goossens, Herman; Coenen, Samuel

doi:10.3399/bjgp18x695789

Cited by 8 publications

(12 citation statements)

References 27 publications

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“…We found no death, a low rate of hospital admissions, an improvement in half of patients after three days and complete recovery in 79% of patients after one month. A benign course of acute cough was also found by Bruyndonckx et al [ 71 ]. A systematic review assessing primary, secondary, and tertiary care found a weighted mean duration of any cough of 17.8 days (range 15.3 to 28.6 days) and 13.9 days for productive cough (range 13.3 to 17.4 days) [ 75 ].…”

Section: Discussionsupporting

confidence: 69%

“…Accurate prediction of the course of cough could decrease antibiotic overprescribing [ 71 , 72 ]. Half of antibiotic prescriptions for acute respiratory conditions in US ambulatory care visits seem to be unnecessary [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

“…As for acute cough, symptom control without diagnosis ('wait and see approach') seems more sensible than investing in unnecessary diagnostic resources [ 76 ]. To reassure patients with low risk, and to confine patients with a high risk of complication, primary care prediction tools like RISSC85 [ 71 ] are helpful.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

et al. 2021

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Background Cough is a relevant reason for encounter in primary care. For evidence-based decision making, general practitioners need setting-specific knowledge about prevalences, pre-test probabilities, and prognosis. Accordingly, we performed a systematic review of symptom-evaluating studies evaluating cough as reason for encounter in primary care. Methods We conducted a search in MEDLINE and EMBASE. Eligibility criteria and methodological quality were assessed independently by two reviewers. We extracted data on prevalence, aetiologies and prognosis, and estimated the variation across studies. If justifiable in terms of heterogeneity, we performed a meta-analysis. Results We identified 21 eligible studies on prevalence, 12 on aetiology, and four on prognosis. Prevalence/incidence estimates were 3.8–4.2%/12.5% (Western primary care) and 10.3–13.8%/6.3–6.5% in Africa, Asia and South America. In Western countries the underlying diagnoses for acute cough or cough of all durations were respiratory tract infections (73–91.9%), influenza (6–15.2%), asthma (3.2–15%), laryngitis/tracheitis (3.6–9%), pneumonia (4.0–4.2%), COPD (0.5–3.3%), heart failure (0.3%), and suspected malignancy (0.2–1.8%). Median time for recovery was 9 to 11 days. Complete recovery was reported by 40.2- 67% of patients after two weeks, and by 79% after four weeks. About 21.1–35% of patients re-consulted; 0–1.3% of acute cough patients were hospitalized, none died. Evidence is missing concerning subacute and chronic cough. Conclusion Prevalences and incidences of cough are high and show regional variation. Acute cough, mainly caused by respiratory tract infections, is usually self-limiting (supporting a “wait-and-see” strategy). We have no setting-specific evidence to support current guideline recommendations concerning subacute or chronic cough in Western primary care. Our study presents epidemiological data under non non-pandemic conditions. It will be interesting to compare these data to future research results of the post-pandemic era.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

et al. 2021

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“…An observational study on the aetiology, diagnosis and prognosis, and a nested RCT on the effect of amoxicillin in adult acute cough patients were conducted between November 2007 and April 2010 within the GRACE Network of Excellence [3,7,9,12]. Patients originated from 16 primary care networks within 12 European countries (Belgium, England, France, Germany, Italy, the Netherlands, Poland, Spain, Slovakia, Slovenia, Sweden and Wales).…”

Section: Datamentioning

confidence: 99%

The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection

et al. 2021

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While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral–bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment.

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“…This study used data from 2604 patients who presented with an acute cough in primary care to develop an algorithm to predict poor outcomes 1. Poor outcome was defined as a reconsultation with new or worsened symptoms, or hospital admission.…”

Section: Overviewmentioning

confidence: 99%

Algorithm to predict poor outcomes from cough

2018

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Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries

Abstract: The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.

Cited by 8 publications

References 27 publications

Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

The Effect of Amoxicillin in Adult Patients Presenting to Primary Care with Acute Cough Predicted to Have Pneumonia or a Combined Viral-Bacterial Infection

Algorithm to predict poor outcomes from cough

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