1. The Research Question A prognostic algorithm to predict hospitalisation among children presenting to primary care with acute cough and RTI: the ‘TARGET’ prospective cohort study Alastair D Hay, Niamh M Redmond, Andrew M Lovering, Barry Vipond, Brendan Delaney, Hannah Christensen, Hannah V Thornton, John P Leeming, Margaret Fletcher, Matthew Thompson, Paul Little, Peter Muir, Sophie Turnbull, Beth Stewart, Tim J Peters and Peter S Blair on behalf of the TARGET study team Can parent-reported symptoms and physical examination findings be used to identify children at high and low risk of hospitalisation for RTI? Why this is important? – New strategies to improve antibiotic use are needed to reduce selective pressure on antimicrobial resistance – Family physicians accept they over-prescribe antibiotics for fear of under-treating children who are subsequently hospitalised

2. What the Researchers Did We recruited >8000 children aged 3 months to just under 16 years presenting to family physicians with acute cough and RTI ≤28 days into a prospective cohort study Family physicians completed a baseline assessment We reviewed medical records for RTI hospitalisation in the 30 days following recruitment We investigated for associations between baseline factors and hospitalisation

3. What the Researchers Found We found four symptoms and three exam findings can be used to distinguish children at high and low risk of hospitalisation. These are: – Age <2 years – Current asthma – Short (≤3 days) illness duration – Moderate/severe vomiting in last 24 hours – Severe fever in last 24 hours – Inter/sub costal recession – Wheeze (on auscultation)

4. What This Means for Clinical Practice Children with 0 to 1 of these seven features have 1:333 risk of hospitalisation and are least likely to benefit from antibiotic treatment Clinicians may wish to adopt a ‘wait and see’ or ‘delayed antibiotic’ strategy for these low risk children The UK National Institute for Health Research (NIHR) funds the ‘TARGET’ Programme Grant for Applied Research at the University of Bristol and NHS Bristol Clinical Commissioning Group. This presentation summarises independent research funded by the 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 UK NHS, the NIHR or the Department of Health.