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

BMJ Open
Martine NurekOlga Kostopoulou

Abstract

The 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. Primary care. 252 GPs, currently practising in the UK. GPs 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. Per vignette, GPs assessed risk of hospitalisation and indicated whether they would prescribe antibiotics or not. GPs 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 assess...Continue Reading

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Software Mentioned

gologit2
Power
STARWAVe
Stata

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