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Parental and clinician agreement of illness severity in children with RTIs: secondary analysis of data from a prospective cohort study

van der Werf ET 1 , Redmond NM 2 , Turnbull S 3 , Thornton H 3 , Thompson M 4 , Little P 5 Show all authors , Peters TJ 6 , Blair PS 6 , Hay AD 3

Affiliations 

  • 1 Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; School of Medicine, Taylor's University, Selangor DE, Malaysia
  • 2 Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol; National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  • 3 Centre for Academic Primary Care, Population Health Sciences
  • 4 Department of Family Medicine, University of Washington, Seattle, WA, US
  • 5 Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
  • 6 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Br J Gen Pract, 2019 Apr;69(681):e236-e245.
PMID: 30858333 DOI: 10.3399/bjgp19X701837

Abstract

BACKGROUND: 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.

METHOD: 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.

RESULTS: 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.

CONCLUSION: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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