DEcision rule for severe Symptoms and Complications of Acute Red Throat in Everyday practice (DESCARTE)

This study will engage hundreds of practices, and thousands of patients and their families directly in the research process. It will potentially provide very practical evidence for both health professionals and the general public about who is at risk - and who is not at risk - for one of the commonest conditions experienced in the general population. Applying this evidence in clinical practice could then potentially make a difference in the management for millions of people, and help in the understanding of both rare outcomes, risk management, and the importance of preserving the precious resource of antibiotics. In the UK alone the clinical rule can potentially be used in 6 million face to face consultations a year , and a similar number of consultation with NHS direct each year for URTIs ? and thus provide an excellent vehicle for the public understanding of and engagement with science.

Setting. This study is based around high volume simplified data collection among a cohort of 600 GPs recruited mainly by postal invitation through existing research Networks at 6 sites.
Methods. Each GP will collect data from 30 patients (18,000 patients in total): baseline clinical data will be collected using a very simple structured proforma. Complications or deterioration of illness will be documented from GP records and from patient report. Prolonged or severe symptoms will be documented among a subsample of patients completing a symptom diary.
From this data set we will develop a clinical prediction rule - to predict a group at high risk of complications - and pilot the rule.
If a rule is found to be predictive the next step will be a subsequent study (i.e. a separate application) to both confirm the predictive value of the rule in a new data set and trial the use of the rule