Parental and clinician agreement of illness severity in children with RTIs: Secondary analysis of data from a prospective cohort study

Esther Van der Werf-Kok, Niamh Redmond, Sophie Turnbull, Hannah Thornton, Matthew Thompson, Paul Little, TJ Peters, Pete Blair, Alastair Hay

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
82 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)E236-E245
Number of pages10
JournalBritish Journal of General Practice
Issue number681
Early online date11 Mar 2019
Publication statusPublished - 1 Apr 2019

Structured keywords

  • BTC (Bristol Trials Centre)
  • BRTC


  • Fever
  • Illness severity assessment
  • Primary health care
  • Respiratory tract infections


Dive into the research topics of 'Parental and clinician agreement of illness severity in children with RTIs: Secondary analysis of data from a prospective cohort study'. Together they form a unique fingerprint.

Cite this