RT Journal Article
SR Electronic
T1 Parental and clinician agreement of illness severity in children with RTIs: secondary analysis of data from a prospective cohort study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e236
OP e245
DO 10.3399/bjgp19X701837
VO 69
IS 681
A1 Esther T van der Werf
A1 Niamh M Redmond
A1 Sophie Turnbull
A1 Hannah Thornton
A1 Matthew Thompson
A1 Paul Little
A1 Tim J Peters
A1 Peter S Blair
A1 Alastair D Hay
YR 2019
UL http://bjgp.org/content/69/681/e236.abstract
AB Background Severity assessments of respiratory tract infection (RTI) in children are known to differ between parents and clinicians, but determinants of perceived severity are unknown.Aim To investigate the (dis)agreement between, and compare the determinants of, parent and clinician severity scores.Design and setting Secondary analysis of data from a prospective cohort study of 8394 children presenting to primary care with acute (≤28 days) cough and RTI.Method Data on sociodemographic factors, parent-reported symptoms, clinician-reported findings, and severity assessments were used. Kappa (κ)-statistics were used to investigate (dis) agreement, whereas multivariable logistic regression was used to identify the factors associated with illness severity.Results Parents reported higher illness severity (mean 5.2 [standard deviation (SD) 1.8], median 5 [interquartile range (IQR) 4–7]), than clinicians (mean 3.1 [SD 1.7], median 3 [IQR 2–4], P<0.0001). There was low positive correlation between these scores (+0.43) and poor inter-rater agreement between parents and clinicians (κ 0.049). The number of clinical signs was highly correlated with clinician scores (+0.71). Parent-reported symptoms (in the previous 24 hours) that were independently associated with higher illness severity scores, in order of importance, were: severe fever, severe cough, rapid breathing, severe reduced eating, moderate-to-severe reduced fluid intake, severe disturbed sleep, and change in cry. Three of these symptoms (severe fever, rapid breathing, and change in cry) along with inter/subcostal recession, crackles/crepitations, nasal flaring, wheeze, and drowsiness/irritability were associated with higher clinician scores.Conclusion Clinicians and parents use different factors and make different judgements about the severity of children’s RTI. Improved understanding of the factors that concern parents could improve parent–clinician communication and consultation outcomes.