title: The TARGET cohort study protocol: a prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses.
abstract: BACKGROUND
  Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation.
  
  
  METHODS
  The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping.
  
  
  CONCLUSIONS
  The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic prescribing would be less warranted. This study will also be the largest natural history study to date of children presenting to primary care with acute cough and respiratory tract infections, and will provide important information on symptom duration, re-consultations and the microbiology of the upper respiratory tract.
authors: Centre for Academic Primary Care, School of Social and Community Based Medicine, NIHR School of Primary Care Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK. niamh.redmond@bristol.ac.uk.
authors: Niamh M
authors: NM
authors: Redmond
authors: Rachel
authors: R
authors: Davies
authors: Hannah
authors: H
authors: Christensen
authors: Peter S
authors: PS
authors: Blair
authors: Andrew M
authors: AM
authors: Lovering
authors: John P
authors: JP
authors: Leeming
authors: Peter
authors: P
authors: Muir
authors: Barry
authors: B
authors: Vipond
authors: Hannah
authors: H
authors: Thornton
authors: Margaret
authors: M
authors: Fletcher
authors: Brendan
authors: B
authors: Delaney
authors: Paul
authors: P
authors: Little
authors: Matthew
authors: M
authors: Thompson
authors: Tim J
authors: TJ
authors: Peters
authors: Alastair D
authors: AD
authors: Hay
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003661:Decision Support Techniques; D006801:Humans; D007223:Infant; D010614:Pharynx / Q000382:microbiology / Q000821:virology; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000821:virology; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
references: Br Med J. 1976 Oct 30;2(6043):1061-4
references: 990762
references: J Antimicrob Chemother. 2006 Aug;58(2):401-7
references: 16735414
references: Br J Gen Pract. 2005 Aug;55(517):603-8
references: 16105368
references: Lancet. 2005 Feb 12-18;365(9459):579-87
references: 15708101
references: Br Med J. 1977 Aug 27;2(6086):552-4
references: 329949
references: Clin Infect Dis. 2005 Aug 15;41(4):490-7
references: 16028157
references: BMJ. 2001 Nov 3;323(7320):1037-41
references: 11691763
references: Stat Methods Med Res. 1997 Jun;6(2):167-83
references: 9261914
references: BMJ. 2007 Nov 10;335(7627):982
references: 17947744
references: BMC Fam Pract. 2013 Jul 28;14:106
references: 23890343
references: BMJ. 2008 Sep 02;337:a1302
references: 18765450
references: BMJ. 2010 May 18;340:c2096
references: 20483949
references: Clin Microbiol Rev. 2006 Jul;19(3):571-82
references: 16847087
references: Br J Gen Pract. 2013 Jul;63(612):e445-54
references: 23834881
references: Br J Gen Pract. 1996 Oct;46(411):589-93
references: 8945796
references: Pediatrics. 2011 Dec;128(6):1053-61
references: 22065263
references: Lancet. 1996 Jun 1;347(9014):1507-10
references: 8684101
references: Eur J Clin Microbiol Infect Dis. 2001 Jul;20(7):445-51
references: 11561799
references: PLoS One. 2012;7(1):e30334
references: 22299036
references: Fam Pract. 2005 Aug;22(4):367-74
references: 15897210
references: BMJ. 2003 Jan 18;326(7381):138
references: 12531847
references: Br J Gen Pract. 2007 Jul;57(540):530-7
references: 17727745
references: BMJ. 1997 Aug 9;315(7104):350-2
references: 9270458
references: Fam Pract. 2001 Oct;18(5):553-4
references: 11604383
references: BMC Fam Pract. 2008 Jan 31;9:10
references: 18237423
references: Arch Dis Child. 2007 Jul;92(7):594-7
references: 17369279
references: Br J Gen Pract. 2004 Jan;54(498):9-14
references: 14965400
references: Fam Pract. 2003 Dec;20(6):696-705
references: 14701895
references: BMJ. 2009 May 28;338:b605
references: 19477892
references: Br J Gen Pract. 2012 Dec;62(605):621-2
references: 23211234
references: J Clin Epidemiol. 1996 Dec;49(12):1373-9
references: 8970487