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Practice Uncertainties page

What factors influence prognosis in children with acute cough and respiratory tract infection in primary care?

BMJ 2012; 345 doi: (Published 20 September 2012) Cite this as: BMJ 2012;345:e6212
  1. Gail Hayward, academic clinical fellow1,
  2. Matthew Thompson, senior clinical scientist1,
  3. Alastair D Hay, general practitioner and reader2
  1. 1Department of Primary Care Health Sciences, Oxford University, Oxford OX1 2ET, UK
  2. 2Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to: G Hayward gail.hayward{at}
  • Accepted 30 July 2012

Cough is the commonest reason for preschool children to see a general practitioner,1 with primary care costs conservatively estimated at £31 million (€38.4 million; $50.3 million) a year for this age group alone.2 Acute cough has been shown to last longer than two weeks in a quarter of preschool children, and up to 12% of children could have deterioration in their condition necessitating reconsultation or complications, including pneumonia.3

Primary care clinicians attempt to balance the need to reduce unnecessary antibiotic prescriptions with the prevention of complications from respiratory tract infections. However, recent guidance from the National Institute for Health and Clinical Excellence4 acknowledged that a key driver for increased antibiotic prescriptions is clinical uncertainty in identifying those children most likely to develop complications or who need hospital care for respiratory infections—that is, those at risk of poorer prognosis. This uncertainty is evident from the wide variation in prescribing rates between individual clinicians, general practices, and countries.5 6 7

What is the evidence of uncertainty?

We researched this question using a literature review (box).

Search strategy for literature review

  • We designed a literature review to answer the following questions:

  • Which factors predict (future) poor prognosis in children presenting to primary care with acute cough and respiratory tract infection?

  • Which factors are associated (in the present) with diagnosis of pneumonia?

  • We performed a systematic literature search of Medline from inception to January 2012 using the following search strategy:

respiratory tract infection [MeSH Terms] OR respiratory infection* OR rti OR lrti OR urti OR lri OR uri OR chest infection* OR cough OR dyspnoea OR congestion OR (lung consolidation) OR (lobar pneumonia) OR (difficult breath*) OR respiration disorder*


child* OR schoolchild* OR preschool* OR pediatric* OR paediatric* OR parent OR parents OR parental OR mother OR father OR mom OR dad OR mum OR caregiver OR guardian OR …

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