Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Fam Pract. 2012 Apr;29(2):131-8. doi: 10.1093/fampra/cmr081. Epub 2011 Oct 6.
Clinicians and patients are often uncertain about the likely clinical course of community-acquired lower respiratory tract infection (LRTI) in individual patients. We therefore set out to develop a prediction rule to identify patients at risk of prolonged illness and those with a benign course.
We determined which signs and symptoms predicted prolonged illness (moderately bad symptoms lasting >3 weeks after consultation) in 2690 adults presenting in primary care with LRTI in 13 European countries by using multilevel modelling.
212 (8.1%) patients experienced prolonged illness. Illness that had lasted >5 days at the time of presentation, >1 episode of cough in the preceding year, chronic use of inhaled pulmonary medication and diarrhoea independently predicted prolonged illness. Applying a rule based on these four variables, 3% of the patients with ≤ 1 variable present (n = 955, 37%) had prolonged illness. Patients with all four variables present had a 30% chance of prolonged illness (n = 71, 3%).
Most patients with acute cough (>90%) recover within 3 weeks. A prediction rule containing four clinical items had predictive value for the risk of prolonged illness, but given its imprecision, appeared to have little clinical utility. Patients should be reassured that they are most likely to recover within three weeks and advised to re-consult if their symptoms persist beyond that period.
临床医生和患者通常不确定社区获得性下呼吸道感染（LRTI）在个体患者中的可能临床过程。因此，我们旨在制定一个预测规则，以识别有患病时间延长风险的患者和具有良性病程的患者。
我们通过使用多层次建模，确定了在 13 个欧洲国家的基层医疗机构中患有 LRTI 的 2690 名成年人中哪些体征和症状预示着患病时间延长（症状中度严重，咨询后持续>3 周）。
212 名（8.1%）患者经历了患病时间延长。就诊时已经持续>5 天的疾病、前一年>1 次咳嗽发作、慢性使用吸入性肺部药物和腹泻均独立预测患病时间延长。应用基于这四个变量的规则，有≤1 个变量的患者（n=955，37%）中，有 3%出现患病时间延长。所有四个变量均存在的患者患病时间延长的几率为 30%（n=71，3%）。
大多数急性咳嗽患者（>90%）在 3 周内恢复。包含四个临床项目的预测规则对患病时间延长的风险具有预测价值，但由于其不精确性，似乎没有太大的临床实用性。患者应得到安慰，他们最有可能在三周内恢复，如果症状持续超过该时间，应建议他们重新就诊。
