A prediction rule for elderly primary-care patients with lower respiratory tract infections.
Prognostic scores for lower respiratory tract infections (LRTI) have been mainly derived in a hospital setting. The current authors have developed and validated a prediction rule for the prognosis of acute LRTI in elderly primary-care patients. Data including demographics, medication use, healthcare use and comorbid conditions from 3,166 episodes of patients aged > or =65 yrs visiting the general practitioner (GP) with LRTI were collected. Multiple logistic regression analysis was used to construct a predictive model. The main outcome measure was 30-day hospitalisation or death. The Second Dutch Survey of GPs was used for validation. The following were independent predictors of 30-day hospitalisation or death: increasing age; previous hospitalisation; heart failure; diabetes; use of oral glucocorticoids; previous use of antibiotics; a diagnosis of pneumonia; and exacerbation of chronic obstructive pulmonary disease. A prediction rule based on these variables showed that the outcome increased directly with increasing scores: 3, 10 and 31% for scores of <2 points, 3-6 and > or =7 points, respectively. Corresponding figures for the validation cohort were 3, 11 and 26%, respectively. This simple prediction rule can help the primary-care physician to differentiate between high- and low-risk patients. As a possible consequence, low-risk patients may be suitable for home treatment, whereas high-risk patients might be monitored more closely in a homecare or hospital setting. Future studies should assess whether information on signs and symptoms can further improve this prediction rule.
Bont
J
J
Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85060, 3508 AB Utrecht, The Netherlands. j.bont@umcutrecht.nl
Hak
E
E
Hoes
A W
AW
Schipper
M
M
Schellevis
F G
FG
Verheij
T J M
TJ
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors