TY - JOUR
T1 - Parental and clinician agreement of illness severity in children with RTIs
T2 - Secondary analysis of data from a prospective cohort study
AU - Van der Werf-Kok, Esther
AU - Redmond, Niamh
AU - Turnbull, Sophie
AU - Thornton, Hannah
AU - Thompson, Matthew
AU - Little, Paul
AU - Peters, TJ
AU - Blair, Pete
AU - Hay, Alastair
PY - 2019/4/1
Y1 - 2019/4/1
N2 - 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.
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.
KW - Fever
KW - Illness severity assessment
KW - Primary health care
KW - Respiratory tract infections
UR - http://www.scopus.com/inward/record.url?scp=85063948155&partnerID=8YFLogxK
U2 - 10.3399/bjgp19X701837
DO - 10.3399/bjgp19X701837
M3 - Article (Academic Journal)
C2 - 30858333
VL - 69
SP - E236-E245
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 681
ER -