Abstract
BackgroundChildren with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear.AimTo develop symptom-based criteria to support parental medical help seeking for children with RTIs.Design and settingA research and development/University of California Los Angeles (RAND/UCLA) appropriateness study to obtain consensus on children’s RTI symptoms appropriate for home, primary, or secondary health care in the UK.MethodA multidisciplinary panel of 12 healthcare professionals — six GPs, two pharmacists, two NHS 111 nurses, and two emergency paediatric consultants — rated the appropriateness of care setting for 1134 scenarios in children aged >12 months.ResultsPanellists agreed that home care would be appropriate for children with ≤1 week of ‘normal’ infection symptoms (cough, sore throat, ear pain, and/or runny nose, with or without eating adequately and normal conscious level). The presence of ≥2 additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the emergency department was considered appropriate when ≥3 symptoms were present and included shortness of breath or wheezing.ConclusionThe authors have defined the RTI symptoms that parents might regard as ‘normal’ and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs.
Highlights
Respiratory tract infections (RTIs) in children are the most common reasons for primary care consultations[1] and antibiotic use,[2] and are a key area for antimicrobial stewardship research.[3]
There is considerable parental uncertainty regarding if, and when, to consult NHS services when children fall ill with respiratory tract infections (RTIs).[6,7]
Parents use a variety of different sources of information about help seeking but report that they are often confusing and unhelpful.[11]. This may be because these sources are influenced by the medicolegal need to detect the small proportion of children with a serious life-threatening illness.[12]
Summary
Respiratory tract infections (RTIs) in children are the most common reasons for primary care consultations[1] and antibiotic use,[2] and are a key area for antimicrobial stewardship research.[3]. There is considerable parental uncertainty regarding if, and when, to consult NHS services when children fall ill with RTIs.[6,7] NHS data show a tenfold between-GPpractice variation in RTI consultation rates.[2] Parents may not possess sufficient understanding regarding the point at which it is appropriate to consult a GP,[8] with around 70% of parents consulting within 1 week of symptoms presenting,[9] many for reassurance.[10,11] Parents use a variety of different sources of information about help seeking (for example, from friends and family, websites with advice, or leaflets) but report that they are often confusing and unhelpful.[11] In part, this may be because these sources are influenced by the medicolegal need to detect the small proportion of children with a serious life-threatening illness.[12]. Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear
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