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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Bibliographic Details
Published in:Annals of family medicine 2019-05, Vol.17 (3), p.231-238
Main Authors: 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
Format: Article
Language:English
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
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Summary: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
ISSN:1544-1709
1544-1717
DOI:10.1370/afm.2386