Imperial College London
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DrOlgaKostopoulou

Faculty of Medicine, Department of Surgery & Cancer

Reader in Medical Decision Making
 
 
 
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Contact

 

o.kostopoulou Website

 
 
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Location

 

5.07Medical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Nurek:2020:10.1136/bmjopen-2019-035761,
author = {Nurek, M and Delaney, BC and Kostopoulou, O},
doi = {10.1136/bmjopen-2019-035761},
journal = {BMJ Open},
title = {Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study},
url = {http://dx.doi.org/10.1136/bmjopen-2019-035761},
volume = {10},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives: The validated “STARWAVe” clinical prediction rule (CPR) uses seven variables  to  guide  risk  assessment  and  antimicrobial  stewardship  in  children presenting with cough(Short illness duration, Temperature, Age, Recession, Wheeze, Asthma,Vomiting). We  aimed  to  compare  General  Practitioners’  (GPs)  risk assessments  and  prescribing  decisions  to  those  of  STARWAVe,  and  assess  the influence of the CPR’s clinical variables. Setting: Primary care. Participants: 252 GPs, currently practising in the UK. Design: GPs  were  randomly  assigned  to  view  four  (of  a  possible  eight)  clinical vignettes  online.  Each  vignette  depicted  a  child  presenting  with  cough,  who  was described  in  terms  of  the  seven  STARWAVe  variables.  Systematically,  we manipulated  patient  age  (20  months  vs.  5  years),  illness  duration  (3  vs.  6  days),vomiting (present vs. absent) and wheeze (present vs. absent), holding the remaining STARWAVe variables constant. Outcome measures:Per vignette, GPs assessed risk of hospitalisation and indicated whether they would prescribe antibiotics or not. Results: GPs overestimated risk of hospitalisationin 9% of vignette presentations (88/1008) and underestimated it in 46% (459/1008). Despite underestimating risk, they overprescribed:  78%  of  prescriptions  were  unnecessary  relative  to  GPs’  own  risk assessments (121/156), while 83% were unnecessary relativeto STARWAVe risk assessments  (130/156).  All  four  of  the  manipulated  variables  influenced  risk assessments,  but  only  three  influenced  prescribing  decisions:  a  shorter  illness duration  reduced  prescribing  odds  (OR  0.14,  95%  CI  0.08-0.27, p<0.001),  while vomiting  and  wheeze  increased  them  (ORvomit2.17,  95%  CI  1.32-3.57, p=0.002; ORwheeze8.98, 95% CI 4.99-16.15, p<0.001). Conclusions: Relative to STARWAVe, GPs underestimated riskof hospitalisation, overprescribed, and appeared to
AU  - Nurek,M
AU  - Delaney,BC
AU  - Kostopoulou,O
DO  - 10.1136/bmjopen-2019-035761
PY  - 2020///
SN  - 2044-6055
TI  - Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study
T2  - BMJ Open
UR  - http://dx.doi.org/10.1136/bmjopen-2019-035761
UR  - http://hdl.handle.net/10044/1/80782
VL  - 10
ER  -
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