Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care.

Détails

ID Serval
serval:BIB_3FFE72EBD074
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care.
Périodique
The British journal of general practice
Auteur(s)
Ebell M.H., Locatelli I., Mueller Y., Senn N., Morgan K.
ISSN
1478-5242 (Electronic)
ISSN-L
0960-1643
Statut éditorial
Publié
Date de publication
11/2018
Peer-reviewed
Oui
Volume
68
Numéro
676
Pages
e765-e774
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Test and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough.
To determine decision thresholds in the management of patients with acute cough.
Set among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients.
Clinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms. The probability of community-acquired pneumonia (CAP) was determined for each vignette based on a multivariate model. A previously published approach based on logistic regression was used to determine test and treatment thresholds.
In total, 256 physicians made 764 clinical decisions. Initial physician estimates systematically overestimated the likelihood of CAP; 75% estimating a higher probability than that predicted by the multivariate model. Given the probability of CAP from a multivariate model, 16.7% (125 of 749) changed their decision from 'treat' to 'test' or 'test' to 'rule out', whereas only 3.5% (26/749) changed their decision from 'rule out' to 'test' or 'test' to 'treat'. Test and treatment thresholds were 9.5% (95% confidence interval (CI) = 8.7 to 10.5) and 43.1% (95% CI = 40.1 to 46.4) and were updated to 12.7% (95% CI = 11.7 to 13.8) and 51.3% (95% CI = 48.3 to 54.9) once the true probability of CAP was given. Test thresholds were consistent between subgroups. Treatment thresholds were higher if radiography was available, for Swiss physicians, and for non-primary care physicians.
Test and treatment thresholds for CAP in patients with acute cough were 9.5% and 43.1%, respectively. Physicians tended to overestimate the likelihood of CAP, and providing information from a clinical decision rule (CDR) changed about 1 in 6 clinical decisions.
Mots-clé
antibiotics, chest, chest radiograph, cough, decision thresholds, decision-making, pneumonia, community-acquired, radiography
Pubmed
Web of science
Création de la notice
05/11/2018 10:51
Dernière modification de la notice
20/08/2019 14:37
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