Global Illness severity assessment and determinants for children with cough and RTI: do parents and clinicians agree?

Talk Code: 
EP2C.10
Presenter: 
Esther Kok
Co-authors: 
Esther T. Kok (1),Niamh M Redmond (1), Sophie Turnbull (1), Hannah Christensen (2), Hannah Thornton (1), Peter S Blair (3), Brendan Delaney (4), Matthew Thompson (5), Paul Little (6), and Alastair D Hay (1)
Author institutions: 
1,2,3 University of Bristol, 4 Imperial College London, 5 University of Washington, Seattle, USA, 6 University of Southampton

Problem

Parent perception of illness severity in children with respiratory tract infections (RTIs) is one of the reasons parents choose to consult primary care, and clinician illness severity assessment is a guiding factor for antibiotic treatment choice. The factors that determine illness severity assessment, are likely to differ between parents and clinicians. In-depth knowledge of these differences and particularly (dis)agreement between parents and clinicians assessments may be important in improving parent-clinician communication and management of children with acute cough and RTI in primary care. Our study aimed to 1) investigate (dis) agreement between clinicians’ and parents’ illness severity scores; and 2) establish and compare the determinants of parent and clinician severity scores.

Approach

We used data from the ‘TARGET’ study, a multicentre prospective cohort study of 8394 children aged 3 months to 16 years with acute (≤28days) cough and RTI. Demographics, parent reported symptoms, clinician reported physical examination findings and illness severity visual-analogue scale (VAS) scores (0 to 10) by parent and clinician were recorded at recruitment.

We used medians and Inter-Quartile Ranges [IQR] as descriptive statistics and the Mann-Whitney test to investigate differences between groups. Correlation was measured using Spearman’s rho. Agreement was measured using kappa statistic and univariable- and multivariable linear regression will be used to identify the socio-demographic, clinical factors (parent-reported symptoms (clinical research form) and clinical history (notes review)) independently associated with parent and clinician reported illness severity.

Findings

Mean severity of illness noted by clinicians was 3.1 (SD= 1.7, median= 3) [Range 0-9, IQR 2-4, range 0-9] for the 8360/8394 (99.6%) children with complete data, compared to mean parental assessment of 5.2 (SD= 1.8, median= 5) [Range 0-10, IQR 4-7, range 0-10] for the 8368/8394 (99.7%) children (p<0.0001) with complete data. We found a moderate positive correlation (Spearmans ρ = 0.434, p=<0.001) between clinician and parent reporting of the severity of the child’s illness. Only 15% of parents and clinicians agreed on the exact score, and in 39% the score was within one point of each other. Univariable and multivariable analyses will be presented.

Consequences

Parent and clinician global severity illness assessment differ in children with RTI consulting primary care, with parents considering their child more severely ill than their clinician. Understanding the reasons for this discrepancy are important in order to provide parents with other ways of assessing severity, which may in turn alter consulting (and re-consulting) behaviour and improve parent anxiety.

Symptoms, signs and demographic factors associated with high illness severity scores will be presented at the conference

Submitted by: 
Esther Kok
Funding acknowledgement: 
This abstract summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.