Consultations for clinical features of possible cancer and associated urgent referrals before and during the COVID-19 pandemic: an observational cohort study from English primary care

Abstract Background It remains unclear to what extent reductions in urgent referrals for suspected cancer during the COVID-19 pandemic were the result of fewer patients attending primary care compared to GPs referring fewer patients. Methods Cohort study including electronic health records data from 8,192,069 patients from 663 English practices. Weekly consultation rates, cumulative consultations and referrals were calculated for 28 clinical features from the NICE suspected cancer guidelines. Clinical feature consultation rate ratios (CRR) and urgent referral rate ratios (RRR) compared time periods in 2020 with 2019. Findings Consultations for cancer clinical features decreased by 24.19% (95% CI: 24.04–24.34%) between 2019 and 2020, particularly in the 6–12 weeks following the first national lockdown. Urgent referrals for clinical features decreased by 10.47% (95% CI: 9.82–11.12%) between 2019 and 2020. Overall, once patients consulted with primary care, GPs urgently referred a similar or greater proportion of patients compared to previous years. Conclusion Due to the significant fall in patients consulting with clinical features of cancer there was a lower than expected number of urgent referrals in 2020. Sustained efforts should be made throughout the pandemic to encourage the public to consult their GP with cancer clinical features.

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P63 The association between presenting clinical features and subsequent diagnosis of giant cell arteritis

Rheumatology ◽

10.1093/rheumatology/keaa111.062 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Lauren A Barnett ◽

Toby Helliwell ◽

Kelvin P Jordan ◽

James A Prior

Keyword(s):

Primary Care ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Clinical Features ◽

Smoking Status ◽

Conditional Logistic Regression ◽

Diagnostic Delay ◽

Practice Research ◽

Clinical Feature ◽

Clinical Practice Research Datalink

Abstract Background The diagnosis of giant cell arteritis (GCA) remains challenging due to the varied number and type of clinical features (symptoms and comorbidities) that patients with GCA can present with. Prompt diagnosis is important, as if left undiagnosed and untreated, some patients may experience irreversible sight loss. Given the rarity of GCA and that many of the presenting clinical features may pertain to other, more prevalent illnesses in the typical age range for GCA, diagnostic delay is common. Such delay may increase the risk of GCA related complications. The aim of this study was to quantify the association between a diagnosis of GCA and the clinical features observed prior to diagnosis. Methods Patients with a coded record of GCA and aged 40 years or older at the time of diagnosis, were identified from the Clinical Practice Research Datalink (CPRD) between 1990 and 2017. CPRD is a large, national UK database of primary care records. Every GCA case was matched to 5 controls with no GCA diagnosis, by year of birth, gender and practice. Clinical features linked to GCA in previous research studies were identified in the patient’s primary care records at any time prior to GCA diagnosis. Conditional logistic regression was used to determine associations between clinical features and a subsequent diagnosis of GCA, adjusting for Body Mass Index, smoking status, and alcohol consumption. Results 9,205 patients with GCA were included, the majority of which were female (70.9%). 15 clinical features were examined. For example, 53.3% of GCA cases had a recorded consultation for headache prior to diagnosis (38.4% within six months prior to diagnosis), compared to 9.9% of controls; 3.2% of cases had recorded jaw pain (0.3% within six months prior to diagnosis) compared to 0.5% of controls; 39.4% of cases had a diagnosis for hypertension prior to their diagnosis of GCA. GCA cases were more likely than controls to have recorded consultations for headache (adjusted OR 10.57; 95% CI: 9.93, 11.25), jaw pain (5.37; 4.47, 6.44) and hypertension (1.33; 1.26, 1.40). Other clinical features that were statistically significantly associated with GCA included fever, anxiety/depression, and PMR. Cancer was the only clinical feature not associated with GCA. Conclusion Symptoms such as headache, jaw pain and hypertension are highly prevalent in GCA, but are also common symptoms in the usual age group affected by GCA and common features of many conditions. In isolation and considering the rarity of GCA in the UK population, these symptoms may not be immediately attributed to GCA by the diagnosing GP. It is therefore necessary to conduct further research where clinical features are not treated independently, but as groups or clusters, which together may more accurately help clinicians to diagnose GCA early. Disclosures L.A. Barnett None. T. Helliwell None. K.P. Jordan None. J.A. Prior None.

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Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

BMJ ◽

10.1136/bmj.m3249 ◽

2020 ◽

pp. m3249 ◽

Cited By ~ 33

Author(s):

Olivia V Swann ◽

Karl A Holden ◽

Lance Turtle ◽

Louisa Pollock ◽

Cameron J Fairfield ◽

...

Keyword(s):

Critical Care ◽

Cohort Study ◽

Young People ◽

Clinical Features ◽

Multivariable Analysis ◽

Case Definition ◽

Observational Cohort Study ◽

Children And Young People ◽

High Dependency ◽

Observational Cohort

Abstract Objective To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). Participants 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. Main outcome measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 10 9 /L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. Conclusions Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). Study registration ISRCTN66726260.

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An observational cohort study to produce and evaluate an improved tool to screen older women with back pain for osteoporotic vertebral fractures (Vfrac): study protocol

Archives of Osteoporosis ◽

10.1007/s11657-019-0558-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

T. K. Khera ◽

A. Burston ◽

S. Davis ◽

S. Drew ◽

R. Gooberman-Hill ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Older Women ◽

Vertebral Fractures ◽

Screening Tool ◽

Observational Cohort Study ◽

Binary Output ◽

Osteoporotic Vertebral Fractures ◽

Observational Cohort

Abstract Summary The aim of this study is to produce an easy to use checklist for general practitioners to complete whenever a woman aged over 65 years with back pain seeks healthcare. This checklist will produce a binary output to determine if the patient should have a radiograph to diagnose vertebral fracture. Purpose People with osteoporotic vertebral fractures are important to be identified as they are at relatively high risk of further fractures. Despite this, less than a third of people with osteoporotic vertebral fractures come to clinical attention due to various reasons including lack of clear triggers to identify who should have diagnostic spinal radiographs. This study aims to produce and evaluate a novel screening tool (Vfrac) for use in older women presenting with back pain in primary care based on clinical triggers and predictors identified previously. This tool will generate a binary output to determine if a radiograph is required. Methods The Vfrac study is a two-site, pragmatic, observational cohort study recruiting 1633 women aged over 65 years with self-reported back pain. Participants will be recruited from primary care in two sites. The Vfrac study will use data from two self-completed questionnaires, a simple physical examination, a lateral thoracic and lateral lumbar radiograph and information contained in medical records. Results The primary objective is to develop an easy-to-use clinical screening tool for identifying older women who are likely to have vertebral fractures. Conclusions This article describes the protocol of the Vfrac study; ISRCTN16550671.

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Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study

British Journal of General Practice ◽

10.3399/bjgp13x669158 ◽

2013 ◽

Vol 63 (612) ◽

pp. e437-e444 ◽

Cited By ~ 18

Author(s):

Gijs Elshout ◽

Yvette van Ierland ◽

Arthur M Bohnen ◽

Marcel de Wilde ◽

Rianne Oostenbrink ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Antibiotic Prescription ◽

Observational Cohort Study ◽

Observational Cohort

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Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

British Journal of General Practice ◽

10.3399/bjgp15x684373 ◽

2015 ◽

Vol 65 (633) ◽

pp. e224-e233 ◽

Cited By ~ 4

Author(s):

Yvette van Ierland ◽

Gijs Elshout ◽

Marjolein Y Berger ◽

Yvonne Vergouwe ◽

Marcel de Wilde ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Primary Care Practice ◽

Observational Cohort Study ◽

Care Practice ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Prediction Rules ◽

Observational Cohort

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Overall infection risk in rheumatoid arthritis during treatment with abatacept, rituximab and tocilizumab; an observational cohort study

Rheumatology ◽

10.1093/rheumatology/kez530 ◽

2019 ◽

Vol 59 (8) ◽

pp. 1949-1956 ◽

Cited By ~ 3

Author(s):

Kathrine L Grøn ◽

Bente Glintborg ◽

Mette Nørgaard ◽

Frank Mehnert ◽

Mikkel Østergaard ◽

...

Keyword(s):

Cohort Study ◽

Relative Risk ◽

Routine Care ◽

Incidence Rates ◽

Observational Cohort Study ◽

Tnf Inhibitor ◽

Observational Cohort ◽

Never Smokers ◽

And Gender ◽

Rate Ratios

Abstract Objectives Most infections in patients with RA are treated in primary care with antibiotics. A small fraction require hospitalization. Only a few studies exist regarding the overall risk of infection (i.e. prescription of antibiotics or hospitalization due to infection) in patients initiating non-TNF-inhibitor therapy. In Danish RA patients initiating abatacept, rituximab and tocilizumab treatment in routine care, the aims were to compare adjusted incidence rates (IR) of infections and to estimate relative risk of infections across the drugs during 0–12 and 0–24 months. Methods This was an observational cohort study including all RA patients in the DANBIO registry starting a non-TNF-inhibitor from 2010 to 2017. Infections were defined as a prescription of antibiotics or hospitalization due to infection. Prescriptions, comorbidities and infections were captured through linkage to national registries. IRs of infections (age, gender adjusted) and rate ratios (as estimates of RR (relative risk)), adjusted for additional covariates) (Poisson regression) were calculated. Results We identified 3696 treatment episodes (abatacept 1115, rituximab 1017, tocilizumab 1564). At baseline, rituximab users were older and had more previous cancer. During 0–12 months, 1747 infections occurred. Age and gender-adjusted IRs per 100 person-years were as follows: abatacept: 76 (95% CI: 69, 84); rituximab: 87 (95% CI: 79, 96); tocilizumab: 77 (95% CI: 71, 84). Adjusted RRs were 0.94 (95% CI: 0.81, 1.08) for abatacept and 0.94 (95% CI: 0.81, 1.03) for tocilizumab compared with rituximab and 1.00 (95% CI: 0.88, 1.14) for abatacept compared with tocilizumab. RRs around 1 were observed after 24 months. Switchers and ever smokers had higher risk compared with biologic-naïve and never smokers, respectively. Conclusion Overall infections were common in non-TNF-inhibitor-treated RA patients, with a tendency towards rituximab having the highest risk, but CIs were wide in all analyses. Confounding by indication may at least partly explain any differences.

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Inequalities in primary care management of knee pain and disability in older adults: an observational cohort study

Rheumatology ◽

10.1093/rheumatology/ker179 ◽

2011 ◽

Vol 50 (10) ◽

pp. 1869-1878 ◽

Cited By ~ 9

Author(s):

C. Jinks ◽

K. Vohora ◽

J. Young ◽

J. Handy ◽

M. Porcheret ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Cohort Study ◽

Knee Pain ◽

Care Management ◽

Observational Cohort Study ◽

Observational Cohort ◽

Primary Care Management

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Common Infections and Antibiotic Prescribing during the First Year of the COVID-19 Pandemic: A Primary Care-Based Observational Cohort Study

Antibiotics ◽

10.3390/antibiotics10121521 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1521

Author(s):

Josi A. Boeijen ◽

Alike W. van der Velden ◽

Saskia Hullegie ◽

Tamara N. Platteel ◽

Dorien L. M. Zwart ◽

...

Keyword(s):

Infectious Disease ◽

Primary Care ◽

Cohort Study ◽

Respiratory Tract ◽

Observational Cohort Study ◽

Antibiotic Prescribing ◽

Prescription Rates ◽

Observational Cohort ◽

Ear Infections ◽

Common Infections

Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care.

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Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: A retrospective cohort study from Wuhan, China

10.21203/rs.3.rs-50577/v1 ◽

2020 ◽

Author(s):

Xunliang Tong ◽

Xiaomao Xu ◽

Guoyue Lv ◽

He Wang ◽

Anqi Cheng ◽

...

Keyword(s):

Influenza Virus ◽

Cohort Study ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Influenza Virus Infection ◽

Clinical Feature ◽

Risk Of Death ◽

New City ◽

Characteristic Features

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infection disease that rapidly spreads worldwide. Co-infection may occur in some cases of COVID-19, like influenza virus and so on. Clinical features and outcomes of severe COVID-19 patients with co-infection of influenza virus need to be noticed.Methods Retrospective cohort study was performed and total of 140 patients with severe COVID-19 was enrolled in designated wards of Sino-French New City Branch of Tongji Hospital between Feb 8th and March 15th in Wuhan, Hubei province, China. The demographic, clinical features, laboratory indices, treatment and outcomes of these patients were collected and analyzed.Results Of 140 severe COVID-19 hospitalized patients, 73 patients were with median age of 66 years old with identification of influenza virus IgM-positive and 67 patients were with median age of 62 years old in influenza virus IgM-negative. Nearly half of severe COVID-19 patients in this research are male. Majority of the severe COVID-19 patients had chronic underlying conditions. Wheeze was the clinical feature of severe COVID-19 patients with influenza IgM-positive (26.4% vs 9.0%, P = 0.008). On contrary, fatigue or myalgia was the feature of the COVID-19 patients without IgM-positive (38.4% vs 58.2%, P = 0.019). Increased levels of ferritin and prolonging APTT were showed in severe COVID-19 patients without influenza IgM-positive compared with patients in other group with significant differences. Death rate in the group of severe COVID-19 patients with influenza IgM-positive is lower than it in other group with significant differences (4.1% vs 14.9%, P = 0.040). In univariate regression analysis, several factors were associated with higher risk of death, which included LDH, troponin, NT-proBNP, D-dimer, PT, APTT, lymphocytes, platelet and eGFR. However, influenza virus IgM positive was associated with lower risk of death.Conclusions Characteristic features of patients with severe COVID-19 with influenza virus IgM-positive were described. Co-infection may occur during the pandemic of COVID-19, and we need to improve our understanding in order to confront this crisis in the future.

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