The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses

Niamh M. Redmond; Rachel Davies; Hannah Christensen; Peter S. Blair; Andrew M. Lovering; John P. Leeming; Peter Muir; Barry Vipond; Hannah Thornton; Margaret Fletcher; Brendan Delaney; Paul Little; Matthew Thompson; Tim J. Peters; Alastair D. Hay

doi:10.1186/1472-6963-13-322

The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses

Niamh M. Redmond^*, Rachel Davies, Hannah Christensen, Peter S. Blair, Andrew M. Lovering, John P. Leeming, Peter Muir, Barry Vipond, Hannah Thornton, Margaret Fletcher, Brendan Delaney, Paul Little, Matthew Thompson, Tim J. Peters, Alastair D. Hay

^*Corresponding author for this work

Bristol Lab Clinical Development

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

Background: Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation. Methods/design. The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping. Discussion. The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic prescribing would be less warranted. This study will also be the largest natural history study to date of children presenting to primary care with acute cough and respiratory tract infections, and will provide important information on symptom duration, re-consultations and the microbiology of the upper respiratory tract.

Original language	English
Article number	322
Journal	BMC Health Services Research
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/1472-6963-13-322
Publication status	Published - 2013

Bibliographical note

Funding Information:
The National Institute for Health Research funds the Programme Grant for Applied Research TARGET Programme grant at the University of Bristol and NHS Bristol Clinical Commissioning Group. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors are extremely grateful to the children, parents/carers and families who have participated in the study, all GP practices including recruiting clinicians, administrative and research contacts and all other staff whose participation made this study possible. We thank colleagues from the TARGET Programme, the TARGET Programme Management Group and the TARGET Programme Steering Committee (Sandra Eldridge, Nick Francis, Joe Kai, Victoria Senior, Anna Thursby-Pelham, Mireille Williams) for their time, expertise and support. We are grateful to the following individuals who have helped with the study; James Austin, Tony Beard, Stephen Beckett, Issy Bray, Peter Brindle, Sue Broomfield, Judy Cordell, Tania Crabb, Hazel Crabb-Wyke, Mike Crawford, Julie Cunningham, Christina Currie, Elizabeth Derodra, Elena Domenech, Stevo Durbaba, Caroline Footer, Emily Gale, Victoria Hardy, Abigail Hay, Lisa Hird, Sandra Hollinghurst, Julie Hooper, Jonathan Hubb, Amy Jepps, Mel Lewcock, Lyn Liddiard, Sharen O’Keefe, Lucy O'Reilly, Marilyn Peters, Aled Picton, Ilaria Pinna, Fiona Redmond, Isabel Richards, Kim Roden, Sharon Salt, Douglas Shedden, Ella Simmonds, Sue Smith, Carol Stanton, Kate Taylor, Nicki Thorne, Sara Tonge, Sophie Turnbull, Abby Waterhouse, Eleanor Woodward. We are grateful for the support of the UK Clinical research networks involved in the study specifically the Primary Care Research Networks, the Primary Care Research Network co-ordinator Natalie Billington, the Medicine for Children’s Research Networks and the Comprehensive Local Research Networks.

Keywords

Children
Cohort study
Primary care
Protocol
Respiratory tract infections (RTIs)
Throat swab

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Redmond, N. M., Davies, R., Christensen, H., Blair, P. S., Lovering, A. M., Leeming, J. P., Muir, P., Vipond, B., Thornton, H., Fletcher, M., Delaney, B., Little, P., Thompson, M., Peters, T. J., & Hay, A. D. (2013). The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses. BMC Health Services Research, 13(1), Article 322. https://doi.org/10.1186/1472-6963-13-322

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title = "The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses",

abstract = "Background: Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation. Methods/design. The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping. Discussion. The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic prescribing would be less warranted. This study will also be the largest natural history study to date of children presenting to primary care with acute cough and respiratory tract infections, and will provide important information on symptom duration, re-consultations and the microbiology of the upper respiratory tract.",

keywords = "Children, Cohort study, Primary care, Protocol, Respiratory tract infections (RTIs), Throat swab",

author = "Redmond, {Niamh M.} and Rachel Davies and Hannah Christensen and Blair, {Peter S.} and Lovering, {Andrew M.} and Leeming, {John P.} and Peter Muir and Barry Vipond and Hannah Thornton and Margaret Fletcher and Brendan Delaney and Paul Little and Matthew Thompson and Peters, {Tim J.} and Hay, {Alastair D.}",

note = "Funding Information: The National Institute for Health Research funds the Programme Grant for Applied Research TARGET Programme grant at the University of Bristol and NHS Bristol Clinical Commissioning Group. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors are extremely grateful to the children, parents/carers and families who have participated in the study, all GP practices including recruiting clinicians, administrative and research contacts and all other staff whose participation made this study possible. We thank colleagues from the TARGET Programme, the TARGET Programme Management Group and the TARGET Programme Steering Committee (Sandra Eldridge, Nick Francis, Joe Kai, Victoria Senior, Anna Thursby-Pelham, Mireille Williams) for their time, expertise and support. We are grateful to the following individuals who have helped with the study; James Austin, Tony Beard, Stephen Beckett, Issy Bray, Peter Brindle, Sue Broomfield, Judy Cordell, Tania Crabb, Hazel Crabb-Wyke, Mike Crawford, Julie Cunningham, Christina Currie, Elizabeth Derodra, Elena Domenech, Stevo Durbaba, Caroline Footer, Emily Gale, Victoria Hardy, Abigail Hay, Lisa Hird, Sandra Hollinghurst, Julie Hooper, Jonathan Hubb, Amy Jepps, Mel Lewcock, Lyn Liddiard, Sharen O{\textquoteright}Keefe, Lucy O'Reilly, Marilyn Peters, Aled Picton, Ilaria Pinna, Fiona Redmond, Isabel Richards, Kim Roden, Sharon Salt, Douglas Shedden, Ella Simmonds, Sue Smith, Carol Stanton, Kate Taylor, Nicki Thorne, Sara Tonge, Sophie Turnbull, Abby Waterhouse, Eleanor Woodward. We are grateful for the support of the UK Clinical research networks involved in the study specifically the Primary Care Research Networks, the Primary Care Research Network co-ordinator Natalie Billington, the Medicine for Children{\textquoteright}s Research Networks and the Comprehensive Local Research Networks.",

year = "2013",

doi = "10.1186/1472-6963-13-322",

language = "English",

volume = "13",

journal = "BMC Health Services Research",

issn = "1472-6963",

publisher = "BioMed Central",

number = "1",

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Redmond, NM, Davies, R, Christensen, H, Blair, PS, Lovering, AM, Leeming, JP, Muir, P, Vipond, B, Thornton, H, Fletcher, M, Delaney, B, Little, P, Thompson, M, Peters, TJ & Hay, AD 2013, 'The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses', BMC Health Services Research, vol. 13, no. 1, 322. https://doi.org/10.1186/1472-6963-13-322

The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses. / Redmond, Niamh M.; Davies, Rachel; Christensen, Hannah et al.
In: BMC Health Services Research, Vol. 13, No. 1, 322, 2013.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The TARGET cohort study protocol

T2 - A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses

AU - Redmond, Niamh M.

AU - Davies, Rachel

AU - Christensen, Hannah

AU - Blair, Peter S.

AU - Lovering, Andrew M.

AU - Leeming, John P.

AU - Muir, Peter

AU - Vipond, Barry

AU - Thornton, Hannah

AU - Fletcher, Margaret

AU - Delaney, Brendan

AU - Little, Paul

AU - Thompson, Matthew

AU - Peters, Tim J.

AU - Hay, Alastair D.

N1 - Funding Information: The National Institute for Health Research funds the Programme Grant for Applied Research TARGET Programme grant at the University of Bristol and NHS Bristol Clinical Commissioning Group. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors are extremely grateful to the children, parents/carers and families who have participated in the study, all GP practices including recruiting clinicians, administrative and research contacts and all other staff whose participation made this study possible. We thank colleagues from the TARGET Programme, the TARGET Programme Management Group and the TARGET Programme Steering Committee (Sandra Eldridge, Nick Francis, Joe Kai, Victoria Senior, Anna Thursby-Pelham, Mireille Williams) for their time, expertise and support. We are grateful to the following individuals who have helped with the study; James Austin, Tony Beard, Stephen Beckett, Issy Bray, Peter Brindle, Sue Broomfield, Judy Cordell, Tania Crabb, Hazel Crabb-Wyke, Mike Crawford, Julie Cunningham, Christina Currie, Elizabeth Derodra, Elena Domenech, Stevo Durbaba, Caroline Footer, Emily Gale, Victoria Hardy, Abigail Hay, Lisa Hird, Sandra Hollinghurst, Julie Hooper, Jonathan Hubb, Amy Jepps, Mel Lewcock, Lyn Liddiard, Sharen O’Keefe, Lucy O'Reilly, Marilyn Peters, Aled Picton, Ilaria Pinna, Fiona Redmond, Isabel Richards, Kim Roden, Sharon Salt, Douglas Shedden, Ella Simmonds, Sue Smith, Carol Stanton, Kate Taylor, Nicki Thorne, Sara Tonge, Sophie Turnbull, Abby Waterhouse, Eleanor Woodward. We are grateful for the support of the UK Clinical research networks involved in the study specifically the Primary Care Research Networks, the Primary Care Research Network co-ordinator Natalie Billington, the Medicine for Children’s Research Networks and the Comprehensive Local Research Networks.

PY - 2013

Y1 - 2013

N2 - Background: Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation. Methods/design. The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping. Discussion. The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic prescribing would be less warranted. This study will also be the largest natural history study to date of children presenting to primary care with acute cough and respiratory tract infections, and will provide important information on symptom duration, re-consultations and the microbiology of the upper respiratory tract.

AB - Background: Children with respiratory tract infections are the single most frequent patient group to make use of primary care health care resources. The use of antibiotics remains highly prevalent in young children, but can lead to antimicrobial resistance as well as reinforcing the idea that parents should re-consult for similar symptoms. One of the main drivers of indiscriminate antimicrobial use is the lack of evidence for, and therefore uncertainty regarding, which children are at risk of poor outcome. This paper describes the protocol for the TARGET cohort study, which aims to derive and validate a clinical prediction rule to identify children presenting to primary care with respiratory tract infections who are at risk of hospitalisation. Methods/design. The TARGET cohort study is a large, multicentre prospective observational study aiming to recruit 8,300 children aged ≥3 months and <16 years presenting to primary care with a cough and respiratory tract infection symptoms from 4 study centres (Bristol, London, Oxford and Southampton). Following informed consent, symptoms, signs and demographics will be measured. In around a quarter of children from the Bristol centre, a single sweep, dual bacterial-viral throat swab will be taken and parents asked to complete a symptom diary until the child is completely well or for 28 days, whichever is sooner. A review of medical notes including clinical history, re-consultation and hospitalisations will be undertaken. Multivariable logistic regression will be used to identify the independent clinical predictors of hospitalisation as well as the prognostic significance of upper respiratory tract microbes. The clinical prediction rule will be internally validated using various methods including bootstrapping. Discussion. The clinical prediction rule for hospitalisation has the potential to help identify a small group of children for hospitalisation and a much larger group where hospitalisation is very unlikely and antibiotic prescribing would be less warranted. This study will also be the largest natural history study to date of children presenting to primary care with acute cough and respiratory tract infections, and will provide important information on symptom duration, re-consultations and the microbiology of the upper respiratory tract.

KW - Children

KW - Cohort study

KW - Primary care

KW - Protocol

KW - Respiratory tract infections (RTIs)

KW - Throat swab

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DO - 10.1186/1472-6963-13-322

M3 - Article

C2 - 23958109

AN - SCOPUS:84881507552

SN - 1472-6963

VL - 13

JO - BMC Health Services Research

JF - BMC Health Services Research

IS - 1

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ER -

The TARGET cohort study protocol: A prospective primary care cohort study to derive and validate a clinical prediction rule to improve the targeting of antibiotics in children with respiratory tract illnesses

Abstract

Bibliographical note

Keywords

UN SDGs

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