Predicting benign course and prolonged illness in lower respiratory tract infections: A 13 European country study
Van Vugt SF., Butler CC., Hood K., Kelly MJ., Coenen S., Goossens H., Little P., Verheij TJ.
Background: Clinicians and patients are often uncertain about the likely clinical course of community-acquired lower respiratory tract infection (LRTI) in individual patients. We therefore set out to develop a prediction rule to identify patients at risk of prolonged illness and those with a benign course. Methods: We determined which signs and symptoms predicted prolonged illness (moderately bad symptoms lasting > 3 weeks after consultation) in 2690 adults presenting in primary care with LRTI in 13 European countries by using multilevel modelling. Results: 212 (8.1%) patients experienced prolonged illness. Illness that had lasted > 5 days at the time of presentation, > 1 episode of cough in the preceding year, chronic use of inhaled pulmonary medication and diarrhoea independently predicted prolonged illness. Applying a rule based on these four variables, 3% of the patients with ≤ 1 variable present (n = 955, 37%) had prolonged illness. Patients with all four variables present had a 30% chance of prolonged illness (n = 71, 3%). Conclusions: Most patients with acute cough ( > 90%) recover within 3 weeks. A prediction rule containing four clinical items had predictive value for the risk of prolonged illness, but given its imprecision, appeared to have little clinical utility. Patients should b e reassured that they are most likely to recover within three weeks and advised to re-consult if their symptoms persist beyond that period. © The Author 2011. Published by Oxford University Press. All rights reserved.