ArticleBMC family practice2013
Visit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective study.
Article in BMC family practice, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
43 citing papers in PubMed, 2 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Defining and Measuring Diagnostic Uncertainty in Medicine: A Systematic Review.Journal of general internal medicine · 2018Pooled it
- Impact of point-of-care C-reactive protein testing intervention on non-prescription dispensing of antibiotics for respiratory tract infections in private community pharmacies in Nigeria: a cluster randomized controlled trial.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Trial
- Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial.Wiener medizinische Wochenschrift (1946) · 2019Trial
- Trial
- Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial.The Lancet. Global health · 2016Trial
- Trial
- Clinicians' views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections.Journal of general internal medicine · 2015Trial
- Point-of-Care Multiplex NAAT for Acute Pharyngitis in the Urgent Care: Detection Patterns, Associated Antimicrobial Prescribing, and Stakeholder Perceptions.Open forum infectious diseases · 2026Article
- Evaluation of the implementation process of POC-CRP devices in managing adults with cough in general practice: insights from a focus group study.Archives of public health = Archives belges de sante publique · 2026Article
- Understanding antimicrobial use by equine owners in Wales: Using cross-sectional survey and semi-structured interviews.Equine veterinary journal · 2026Article
- Unclear Trajectory and Uncertain Benefit: Creating a Lexicon for Clinical Uncertainty in Patients with Critical or Advanced Illness Using a Delphi Consensus Process.Medical decision making : an international journal of the Society for Medical Decision Making · 2025Article
- How is diagnostic uncertainty communicated and managed in real world primary care settings?BMC primary care · 2024Article
- Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial.BMC medical informatics and decision making · 2023Article
- A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children.BMC pediatrics · 2023Article
- What is in the toolkit (and what are the tools)? How to approach the study of doctor-patient communication.Postgraduate medical journal · 2023Article
- The conceptualization of acute bronchitis in general practice - a fuzzy problem with consequences? A qualitative study in primary care.BMC primary care · 2023Article
- The Effect of Implementation of Guideline Order Bundles Into a General Admission Order Set on Clinical Practice Guideline Adoption: Quasi-Experimental Study.JMIR medical informatics · 2023Article
- Addressing Antimicrobial Stewardship in Primary Care-Developing Patient Information Sheets Using Co-Design Methodology.Antibiotics (Basel, Switzerland) · 2023Article
- Understanding antibiotic-seeking behaviour: A qualitative case study of mothers of children aged 5 and under.Journal of advanced nursing · 2022Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundGuidelines and performance measures recommend avoiding antibiotics for acute cough/acute bronchitis and presume visits are straightforward with simple diagnostic decision-making. We evaluated clinician-assigned diagnoses, diagnostic uncertainty, and antibiotic prescribing for acute cough visits in primary care.
methodsWe conducted a retrospective analysis of acute cough visits - cough lasting ≤21 days in adults 18-64 years old without chronic lung disease - in a primary care practice from March 2011 through June 2012.
resultsOf 56,301 visits, 962 (2%) were for acute cough. Clinicians diagnosed patients with 1, 2, or ≥ 3 cough-related diagnoses in 54%, 35%, and 11% of visits, respectively. The most common principal diagnoses were upper respiratory infection (46%), sinusitis (10%), acute bronchitis (9%), and pneumonia (8%). Clinicians prescribed antibiotics in 22% of all visits: 65% of visits with antibiotic-appropriate diagnoses and 4% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed diagnostic uncertainty in 16% of all visits: 43% of visits with antibiotic-appropriate diagnoses and 5% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed uncertainty more often when prescribing antibiotics than when not prescribing antibiotics (30% vs. 12%; p < 0.001). As the number of visit diagnoses increased from 1 to 2 to ≥ 3, clinicians were more likely to express diagnostic uncertainty (5%, 25%, 40%, respectively; p < 0.001) and prescribe antibiotics (16%, 25%, 41%, respectively; p < 0.001).
conclusionsAcute cough may be more complex and have more diagnostic uncertainty than guidelines and performance measures presume. Efforts to reduce antibiotic prescribing for acute cough should address diagnostic complexity and uncertainty that clinicians face.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.