Labelling of acute respiratory illness: evidence of between-practitioner variation in the UK.
BACKGROUND
It is unclear which symptoms and signs GPs use when attributing diagnostic labels to patients with acute respiratory illness (ARI).


OBJECTIVE
We sought to ascertain GPs' self-reported definitions of ARI.


METHODS
A postal questionnaire concerned with the diagnosis of ARI was sent to all registered GPs in Avon Health Authority. GPs were asked to choose a clinical term that would describe the clinical presentation in four hypothetical patients, and the next three questions asked them to define acute bronchitis, upper respiratory tract infection (URTI) and any other term they used for ARI (excluding pneumonia). We measured proportions and compared responses across the three diagnostic categories.


RESULTS
The majority (88%) of GPs agreed that cough associated with fever should be labelled as a URTI. When sputum and chest signs were also present, opinion was more divided, with 62% diagnosing acute bronchitis in young patients and 72% lower respiratory tract infection in old patients.


CONCLUSIONS
This study demonstrates that there is more consistent use of diagnostic labels for URTI than for acute bronchitis or other terms used to label ARI. In the future, researchers should quantify the prognostic significance of symptoms and signs in ARI and provide GPs with a more rational approach to the diagnosis and management of ARI.
Department of General Practice, University of Adelaide, Adelaide 5005, Australia. nigel.stocks@adelaide.edu.au
Nigel
N
Stocks
Tom
T
Fahey
D000208:Acute Disease; D000328:Adult; D001991:Bronchitis / Q000175:diagnosis; D005194:Family Practice; D006801:Humans; D012141:Respiratory Tract Infections / Q000175:diagnosis*; D009626:Terminology as Topic; D006113:United Kingdom