Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study

ObjectivesThe validated ‘STARWAVe’ (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting) clinical prediction rule (CPR) uses seven variables to guide risk assessment and antimicrobial stewardship in children presenting with cough. We aimed to compare general practitioners’...

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Bibliographic Details
Published in:BMJ open 2020-07, Vol.10 (7), p.e035761-e035761
Main Authors: Nurek, Martine, Delaney, Brendan C, Kostopoulou, Olga
Format: Article
Language:English
Subjects:
Age
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobial agents
Antimicrobial Stewardship
Asthma
Cancer
Child
Clinical Decision-Making
Cough - drug therapy
General practice / Family practice
General Practitioners
Hospitalization
Humans
Practice Patterns, Physicians' - statistics & numerical data
Prescriptions
Primary care
Public health
Questionnaires
Recessions
Risk Assessment
United Kingdom
Vomiting
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Summary:ObjectivesThe validated ‘STARWAVe’ (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting) clinical prediction rule (CPR) uses seven variables to guide risk assessment and antimicrobial stewardship in children presenting with cough. We aimed to compare general practitioners’ (GPs) risk assessments and prescribing decisions to those of STARWAVe and assess the influence of the CPR’s clinical variables.SettingPrimary care.Participants252 GPs, currently practising in the UK.DesignGPs were randomly assigned to view four (of a possible eight) clinical vignettes online. Each vignette depicted a child presenting with cough, who was described in terms of the seven STARWAVe variables. Systematically, we manipulated patient age (20 months vs 5 years), illness duration (3 vs 6 days), vomiting (present vs absent) and wheeze (present vs absent), holding the remaining STARWAVe variables constant.Outcome measuresPer vignette, GPs assessed risk of hospitalisation and indicated whether they would prescribe antibiotics or not.ResultsGPs overestimated risk of hospitalisation in 9% of vignette presentations (88/1008) and underestimated it in 46% (459/1008). Despite underestimating risk, they overprescribed: 78% of prescriptions were unnecessary relative to GPs’ own risk assessments (121/156), while 83% were unnecessary relative to STARWAVe risk assessments (130/156). All four of the manipulated variables influenced risk assessments, but only three influenced prescribing decisions: a shorter illness duration reduced prescribing odds (OR 0.14, 95% CI 0.08 to 0.27, p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2019-035761