RT Journal Article
SR Electronic
T1 Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e342
OP e350
DO 10.3399/bjgp18X695789
VO 68
IS 670
A1 Robin Bruyndonckx
A1 Niel Hens
A1 Theo JM Verheij
A1 Marc Aerts
A1 Margareta Ieven
A1 Christopher C Butler
A1 Paul Little
A1 Herman Goossens
A1 Samuel Coenen
A1 The GRACE project group
YR 2018
UL http://bjgp.org/content/68/670/e342.abstract
AB Background Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care.Aim The authors set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms, or hospital admission) in adults presenting to primary care with acute cough.Design and setting Data were collected from 2604 adults presenting to primary care with acute cough or symptoms suggestive of lower respiratory tract infection (LRTI) within the Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE; www.grace-lrti.org) Network of Excellence.Method Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared with that of existing prediction rules, using the models’ area under the receiver operator characteristic curve (AUC), and any improvement obtained by including additional test results (C-reactive protein [CRP], blood urea nitrogen [BUN], chest radiography, or aetiology) was evaluated using the same methodology.Results The new prediction rule, included the baseline Risk of poor outcome, Interference with daily activities, number of years stopped Smoking (> or <45 years), severity of Sputum, presence of Crackles, and diastolic blood pressure (> or <85 mmHg) (RISSC85). Though performance of RISSC85 was moderate (sensitivity 62%, specificity 59%, positive predictive value 27%, negative predictive value 86%, AUC 0.63, 95% confidence interval [CI] = 0.61 to 0.67), it outperformed all existing prediction rules used today (highest AUC 0.53, 95% CI = 0.51 to 0.56), and could not be significantly improved by including additional test results (highest AUC 0.64, 95% CI = 0.62 to 0.68).Conclusion 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.