Post consultation symptom trajectories in children presenting to primary care with acute cough and respiratory tract infection: latent class analysis of the ‘TARGET’ prospective cohort study
Problem
Accurate advice for parents regarding post-consultation symptom trajectories in children with respiratory tract infections (RTIs) has two potential benefits: (i) improved safety-netting by helping parents know if their child’s experience is normal; and (ii) the setting of realistic expectations regarding symptom duration and severity. Both are likely to help parents make better decisions regarding the need to re-attend. To our knowledge, previous studies have reported only post-consultation symptom duration. The aim of this study is to investigate if distinct post-consultation symptom trajectory groups can be defined among children presenting to primary care with acute cough and RTI.
Approach
We used data from the ‘TARGET’ multicentre, prospective cohort study of children aged 3 months to 16 years with acute (≤28 days) cough and RTI. Parents of 2296 children recruited to the Bristol centre completed a symptom diary recording the severity of six symptoms (cough, shortness of breath, disturbed sleep, being unwell, coping with normal activities and fever) on a 7-item Likert scale (from zero 'normal’ to six ‘as bad as can be’) for 28 days or until they scored `normal` on all symptoms on two consecutive days. We used survival analysis to estimate symptom duration and latent class analysis to identify post-consultation trajectory groups.
Findings
Complete symptom diaries were available from 1408 (61.3%) children. Children with and without diary data did not differ by age (mean 4.1 vs 4.2 years, p=0.70), gender (53% vs 50% male, p=0.22), or ethnicity (89% vs 87% white, p=0.14). Symptom diary data show cough was the most persistent symptom with a median duration of ‘moderately bad or worse’ (≥3) cough of 3 days (interquartile range 1-5) and overall duration of 9 days (6-14). Median overall duration of other symptoms were: shortness of breath 4 days (1-8), disturbed sleep 6 days (3-9), unwell 7 days (4-10), interference with daily activities 5 days (3-8), and fever 2 days (0-5). Preliminary latent class analyses of cough severity define four groups: (i) ‘severe’ (6% of children), the only group to experience a deterioration post-consultation and this group had the longest and most severe trajectory; (ii) the ‘short’ group (49%)steadily improved, resolving within 5 days; (iii) the ‘delayed’ group (35%) also steadily improved, resolving by day 11 and finally; (iv) the ‘persistent’ group (10%) were still symptomatic at day 15.
Consequences
Parents can be advised that most (94%) of children’s coughs exclusively improve post-consultation. Further analyses will be conducted to identify predictors of group membership, which could be used to further reduce clinical uncertainty and improve the accuracy of safety-netting advice for parents.