GPs ‘can rule out pneumonia’ in children
medwireNews: GPs can use simple clinical assessments to rule out pneumonia risk in children who present with acute cough, report the authors of a literature review.
The approach could help primary care clinicians avoid prescribing antibiotics unnecessarily, without missing those children who are more likely to develop the complication.
Dr Gail Hayward (Oxford University) and colleagues say that GPs lack clear evidence on how to identify children who will benefit most from antibiotic treatment - which they are under increasing pressure not to prescribe.
"Recent guidance from [NICE] acknowledged that a key driver for increased antibiotic prescriptions is clinical uncertainty in identifying those children most likely to develop complications or who need hospital care for respiratory infections," they note in the BMJ.
The researchers found only two studies of clinical rules for predicting poor prognosis in children with cough and respiratory tract infections. They therefore focused on factors associated with pneumonia, for which more evidence is available.
Hayward and team conclude that two clinical features can be used to rule out pneumonia - the absence of the GP's impression that the child is unwell and the absence of difficult or laboured breathing. A prospective cohort study of 3,981 patients showed that the combination of these two factors had a 100% negative predictive value to rule out pneumonia but only a 5.3% positive predictive value to rule it in.
They also recommend that GPs look for signs and symptoms such as raised respiratory rate, chest signs, and fever, which have been shown in emergency settings to both rule in and rule out pneumonia.
However, they conclude that "in practice, the decision to prescribe antibiotics or arrange admission for a child with acute cough and respiratory infection will be guided not only by these clinical features but also by parental concern, previous medical problems, and the ability to use careful safety-netting".
medwireNews (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Kirsty Oswald