Journal
FAMILY PRACTICE
Volume 30, Issue 4, Pages 379-385Publisher
OXFORD UNIV PRESS
DOI: 10.1093/fampra/cmt006
Keywords
Decision making; evidence-based medicine; family practice; patient-centered care; prognosis; upper respiratory tract infections
Categories
Funding
- Health Resources and Services Administration [T32HP10010]
- National Center for Research Resources [1UL1RR025011]
- National Center for Advancing Translational Sciences [9U54TR000021]
- National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health [NIH NCCAM 1-RO1-AT-1428]
- NCCAM [K23 AT00051]
- University of Wisconsin School of Medicine and Public Health
- University of Wisconsin Department of Family Medicine
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Acute upper respiratory infections (URI) are the second most common diagnosis in primary care offices. As treatments have limited effectiveness, patient counseling regarding expectations for the course of the URI is an important aspect of care. It is unknown how accurate patients, clinicians or questionnaires such as the Wisconsin Upper Respiratory Symptom Survey (WURSS) instrument are at predicting URI severity and duration, and whether these predictions should be used to counsel patients. Seven hundred and nineteen individuals with recent onset cold in community clinic settings participated. Participants and clinicians predicted the severity and duration of the URI and participants completed the WURSS instrument at initial visit. Subsequent URI global severity was calculated as area under the curve using an average of twice-daily WURSS-21 self-reports as the y-axis and illness duration as the x-axis. URI duration was determined by self-report of beginning and end of illness. Linear regression analysis was used to correlate baseline predictions with subsequent outcomes. Analyses by gender, age and income were also performed. There was no significant association between participant and clinician predictions of severity or duration. Initial WURSS values explained 0.119 (95% CI: 0.0740.163) of the variance in subsequent severity outcomes. There were no significant differences in associations by age, gender or income. Clinicians should not use their predictive assessments or their patients predictions when advising patients on the expected course of a URI. This study also suggests that the WURSS instrument could give some predictive information, but whether this is clinically useful is uncertain.
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