A clinical rule developed by researchers from the United Kingdom can help general practitioners and nurses in primary care distinguish children at very low, normal, and high risk of future hospital admission for respiratory tract infection (RTI) and can help reduce antibiotic prescriptions for children at very low risk, according to a study published inThe Lancet Respiratory Medicine.
Up to 1/3 of the prescriptions written for RTI with cough for children may be unnecessary. Study authors predict that if antibiotic prescribing in the low risk group was cut in half, and even if prescribing increased to 90% in high risk patients, the new clinical tool could decrease antibiotic prescribing to children with RTI and coughs by 10%.
The first-of-its-kind study included 8,394 children aged 3 months–16 years presenting with acute cough (<28 days) and RTI who were seen at general practices across England. The study’s outcome was hospital admission for RTI within 30 days, collected using a structured, blinded review of health records.
Based on the findings, the authors developed STARWAVe, a 7-item scoring system to predict a child’s risk of future hospitalization. These predictors can be easily detected by doctors and nurses during a patient’s visit:
- Short illness (<3 days)
- High temperature (≥37.8°C on examination or parent reported severe fever in the previous 24 hours)
- Age <2yrs
- Respiratory distress
- Moderate/severe vomiting in the previous 24hrs
Children who present with no more than 1 of these factors are considered very low risk for future complications. For normal risk children, the authors recommend a “no antibiotic or delayed antibiotic” treatment strategy as recommended by NICE. Children at high risk of hospitalization should be closely monitored for signs of deterioration and followed-up within 24 hours.
The accuracy of STARWAVe was assessed via AUROC (area under the receiver operating characteristic curve). The new rule produced an AUROC of 0.81, indicating it should predict the risk of hospitalization with high accuracy. Although STARWAVe requires further external validation in a randomized trial setting, it can be a useful tool to help guide antibiotic prescribing decisions and potentially reduce prescribing based on “prognostic uncertainty or on nonmedical grounds,” the authors noted.
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