ArticleBMJ open2020
Risk assessment and antibiotic prescribing decisions in children presenting to UK primary care with cough: a vignette study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Comparing GPs' antibiotic prescribing decisions to a clinical prediction rule: an online vignette study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Trial
- Is C-reactive protein the answer to antibiotics over-prescribing in primary care? A behavioural experiment in two European countries.JAC-antimicrobial resistance · 2026Article
- Parents' perspectives on childhood antibiotic treatment in Ireland-a qualitative study.JAC-antimicrobial resistance · 2025Article
- Using cancer risk algorithms to improve risk estimates and referral decisions.Communications medicine · 2022Article
- Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study.Antibiotics (Basel, Switzerland) · 2021Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe validated 'STARWAVe' (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting) clinical prediction rule (CPR) uses seven variables to guide risk assessment and antimicrobial stewardship in children presenting with cough. We aimed to compare general practitioners' (GPs) risk assessments and prescribing decisions to those of STARWAVe and assess the influence of the CPR's clinical variables.
settingPrimary care.
participants252 GPs, currently practising in the UK.
designGPs were randomly assigned to view four (of a possible eight) clinical vignettes online. Each vignette depicted a child presenting with cough, who was described in terms of the seven STARWAVe variables. Systematically, we manipulated patient age (20 months vs 5 years), illness duration (3 vs 6 days), vomiting (present vs absent) and wheeze (present vs absent), holding the remaining STARWAVe variables constant. OUTCOME MEASURES: Per vignette, GPs assessed risk of hospitalisation and indicated whether they would prescribe antibiotics or not.
resultsGPs overestimated risk of hospitalisation in 9% of vignette presentations (88/1008) and underestimated it in 46% (459/1008). Despite underestimating risk, they overprescribed: 78% of prescriptions were unnecessary relative to GPs' own risk assessments (121/156), while 83% were unnecessary relative to STARWAVe risk assessments (130/156). All four of the manipulated variables influenced risk assessments, but only three influenced prescribing decisions: a shorter illness duration reduced prescribing odds (OR 0.14, 95% CI 0.08 to 0.27, p<0.001), while vomiting and wheeze increased them (OR
conclusionsRelative to STARWAVe, GPs underestimated risk of hospitalisation, overprescribed and appeared to misinterpret illness duration (prescribing for longer rather than shorter illnesses). It is important to ascertain discrepancies between CPRs and current clinical practice. This has implications for the integration of CPRs into the electronic health record and the provision of intelligible explanations to decision-makers.
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