The effect of parental expectations on treatment of children with a cough: a report from ASPN.

A previous retrospective study of children with cough raised questions about how physicians diagnose acute bronchitis. We hypothesized that if the physician perceives a parental expectation that an antibiotic is needed, it is more likely that a child with a cough will be diagnosed as having bronchitis and treated with an antibiotic. Data were collected prospectively in 44 primary care practices in the Ambulatory Sentinel Practice Network. Variables examined included elements of the patient's history and physical examination, diagnoses made, and treatments prescribed. Data regarding 1398 patients were collected. A parental expectation that a prescription for an antibiotic would be given was associated with an increased likelihood of a diagnosis of bronchitis (relative risk 2.04, 95% confidence limits, 1.76 to 2.35, P < .001), and was second only to the physical finding of rales in the magnitude of its association with that diagnosis. The only other diagnosis associated with parental expectation of an antibiotic was viral upper respiratory tract infection, where parental expectation of treatment with an antibiotic was associated with a 49% reduction in the probability of that diagnosis. The expectations of parents of children with a cough appear to influence physician decision making.