title: The CHICO (Children's Cough) Trial protocol: a feasibility randomised controlled trial investigating the clinical and cost-effectiveness of a complex intervention to improve the management of children presenting to primary care with acute respiratory tract infection.
abstract: BACKGROUND
  While most respiratory tract infections (RTIs) will resolve without treatment, many children will receive antibiotics and some will develop severe symptoms requiring hospitalisation. There have been calls for evidence to reduce uncertainty regarding the identification of children who will and will not benefit from antibiotics. The aim of this feasibility trial is to test recruitment and the acceptance of a complex behavioural intervention designed to reduce antibiotic prescribing, and to inform how best to conduct a larger trial.
  
  
  METHODS
  The CHICO (Children's Cough) trial is a single-centre feasibility cluster randomised controlled trial (RCT) comparing a web-based, within-consultation, behavioural intervention with usual care for children presenting to general practitioner practices with RTI and acute cough. The trial aims to recruit at least 300 children between October 2014 and April 2015, in a single area in South West England. Following informed consent, demographic information will be recorded, and symptoms and signs measured. Parents/carers of recruited children will be followed up on a weekly basis to establish symptom duration, resource use and cost of the illness to the parent until the child's cough has resolved or up to 8 weeks, whichever occurs earlier. A review of medical notes, including clinical history, primary care reconsultations and hospitalisations will be undertaken 2 months after recruitment. The trial feasibility will be assessed by: determining acceptability of the intervention to clinicians and parent/carers; quantifying differential recruitment and follow-up; determining intervention fidelity; the success in gathering the data necessary to conduct a cost-effectiveness analysis; and collecting data about antibiotic prescribing rates to inform the sample size needed for a fully powered RCT.
  
  
  BACKGROUND
  The study was approved by the North West-Haydock Research Ethics Committee, UK (reference number: 14/NW/1034). The findings from this feasibility trial will be disseminated through research conferences and peer-reviewed journals.
  
  
  BACKGROUND
  ISRCTN23547970.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sophie L
authors.initials: SL
authors.lastname: Turnbull
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Redmond
authors.affiliation: School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lucas
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Christie
authors.initials: C
authors.lastname: Cabral
authors.affiliation: School of Social and Community Medicine, Centre for Child and Adolescent Health, Bristol, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ingram
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Sandra
authors.identifier: http://orcid.org/0000-0003-0782-3117
authors.initials: S
authors.lastname: Hollinghurst
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Horwood
authors.affiliation: Department of Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Institute of Primary Care and Public Health, University of Cardiff, Cardiff, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Francis
authors.affiliation: School of Social and Community Medicine, Centre for Child and Adolescent Health, Bristol, UK.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Blair
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003371:Cough / Q000188:drug therapy*; D019468:Disease Management; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D011320:Primary Health Care / Q000458:organization & administration*; D012141:Respiratory Tract Infections / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: PRIMARY CARE; RESPIRATORY MEDICINE (see Thoracic Medicine)