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Publication - Dr Esther Van der Werf-Kok

    Parental and clinician agreement of illness severity in children with RTIs

    Secondary analysis of data from a prospective cohort study


    Werf-Kok, EVd, Redmond, N, Turnbull, S, Thornton, H, Thompson, M, Little, P, Peters, T, Blair, P & Hay, A, 2019, ‘Parental and clinician agreement of illness severity in children with RTIs: Secondary analysis of data from a prospective cohort study’. British Journal of General Practice, vol 69., pp. E236-E245


    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.

    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.

    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.

    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.

    Full details in the University publications repository