title: Can patients or clinicians predict the severity or duration of an acute upper respiratory infection?
abstract: OBJECTIVE
  Acute upper respiratory infections (URI) are the second most common diagnosis in primary care offices. As treatments have limited effectiveness, patient counseling regarding expectations for the course of the URI is an important aspect of care. It is unknown how accurate patients, clinicians or questionnaires such as the Wisconsin Upper Respiratory Symptom Survey (WURSS) instrument are at predicting URI severity and duration, and whether these predictions should be used to counsel patients.
  
  
  METHODS
  Seven hundred and nineteen individuals with recent onset cold in community clinic settings participated. Participants and clinicians predicted the severity and duration of the URI and participants completed the WURSS instrument at initial visit. Subsequent URI global severity was calculated as area under the curve using an average of twice-daily WURSS-21 self-reports as the y-axis and illness duration as the x-axis. URI duration was determined by self-report of beginning and end of illness. Linear regression analysis was used to correlate baseline predictions with subsequent outcomes. Analyses by gender, age and income were also performed.
  
  
  RESULTS
  There was no significant association between participant and clinician predictions of severity or duration. Initial WURSS values explained 0.119 (95% CI: 0.074-0.163) of the variance in subsequent severity outcomes. There were no significant differences in associations by age, gender or income.
  
  
  CONCLUSIONS
  Clinicians should not use their predictive assessments or their patients' predictions when advising patients on the expected course of a URI. This study also suggests that the WURSS instrument could give some predictive information, but whether this is clinically useful is uncertain.
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Alumni Hall, 1100 Delaplaine ct, Madison, WI 53715, USA. Elizabeth.longmier@fammed.wisc.edu
authors.forename: E
authors.initials: E
authors.lastname: Longmier
authors.forename: B
authors.initials: B
authors.lastname: Barrett
authors.forename: R
authors.initials: R
authors.lastname: Brown
mesh_terms: D000328:Adult; D019091:Critical Pathways / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010358:Patient Participation / Q000379:methods / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014481:United States
keywords: Decision making; evidence-based medicine; family practice; patient-centered care; prognosis; upper respiratory tract infections.