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In routine primary care practice, serious adverse outcomes occur in only 1% of adult patients with lower respiratory tract infection, but such outcomes may be predicted with moderate accuracy. In a prospective cohort study of 28,846 adult patients with lower respiratory tract infections, researchers recorded patient characteristics and clinical findings, and identified adverse events (i.e., late onset pneumonia, hospital admission, or death) during a 30-day period following the patient visit. Serious adverse outcomes occurred in only 325 out of 28,846 patient visits. Three categories of factors independently predicted adverse outcomes from lower respiratory tract infection: severity of patient symptoms, patient vulnerability to serious illness, and the physiological impact of symptoms. These factors can be used to predict adverse outcomes by conversion to an eight-point score. Since patients with respiratory tract infection get little if any benefit from antibiotics, the authors state, the score may help clinicians target prescribing based on predicted risk and identify a small group of high risk patients who may benefit from closer monitoring.
Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections
Michael Moore, BM, BS, MRCP, et al.
University of Southampton, Southampton, United Kingdom