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Table 2: Characteristics of the included studies

From: Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

Study

Country

Setting

Time of recruite-ment

Data assessment

Study population:

number

female

Age in sample

(years)

Inclusion (IN) / Exclusion (EX) criteria

Out-come

Ajmi 2011 [16]

Tunisia

86 primary health care centres

06/2002–05/2003

prospectively

16,271 consultations

24,882 RFE

♀ 62%

0–103

Ø 24

IN: medical records randomly selected

pre

Albert 2011 [17]

USA

Internet-based medical visits on the University of Pittsburgh Medical Center HealthTrak e-Visit system, users receiving care from a large family medicine practice

08–11/2009

prospectively

121 e-visits

♀ 71%

18–60 + 

IN: adult users of an e-visit-system

pre

BEACH Program [18]

Australia

965 randomly selected GPs

04/2015–03/2016

prospectively

97,398 consultations 149,084 RFE

♀ 57%

0–75 + 

IN: doctor-patient encounters of all types

pre

Ben Abdelaziz 2004 [19]

Tunisia

6 primary healthcare facilities in the Tunisian Sahel (Sousse)

02/2000–01/2001

prospectively

4022 consultations

6576 RFE

♀ 66,6%

0–100 + 

Ø 27

IN: all patient-doctor encounters in a randomly chosen 30-day period

pre

Coenen 2004 [20]

Belgium

85 Flemish GPs

02–04/2000 and 02–04/2001

prospectively

810 patients (514 after follow-up)

♀ 57%

Ø 40.9

IN: immunocompetent patients, 18–65 years, new or worsening coughing less than 30 days as (one of) the most important complaint(s) and reason for first encounter

prog

CONTENT Project [21, 22]

Germany

17 general practices in 4 federal states resp. 1 rural out of hours-care centre with 41 GPs

04/2005– 12/2006 resp.

07/2008–06/2011

prospectively

42,469 patients

27,871 RFE resp.

9542 patients

15,886 consultations

♀ 59,7–66%

0–104

Ø 42–48.6

IN: (main) RFE were coded

pre

aet

French 2005 [23]

USA

1 walk-in primary care clinic of an academic, tertiary care medical centre

n.r.

prospectively

62 patients

♀ 51,6%

19–88

♀ Ø 42

♂ Ø 48

IN: cough < 3 weeks duration

EX: none

aet

GRACE Study [24,25,26,27,28,29,30,31,32,33,34]

Belgium, France, Germany, Italy, Netherlands, Poland, Spain, Slovakia, Slovenia, Sweden, UK

294 – 387 GPs in 125 general practices from 16 primary care networks

10/2007–04/2010

resp.

10/2006–03/2007

prospectively

1801 – 3368 patients

♀60–70%

18–61 + 

Ø45-50

IN: ≥ 18 years, acute or worsened cough (≤ 28 days duration) as main/dominant symptom, or suggested LRTI, consulting for the first time for this illness episode

EX: immune deficiency

aet

prog

Hamre 2005 [35]

Austria, Germany, Netherlands, UK, USA

29 primary care practices with 37 GPs

04/1999–03/2000

prospectively

318 patients (301 after follow-up)

♀ 60%

 < 5–65 + 

64.9%

 ≥ 18

IN: age ≥ 1 month, chief complaint of cough ≤ 7 days

EX: dementia, renal failure, severe hepatic disease, ongoing immunosuppressive treatment, chemotherapy or radiotherapy, alcohol or drug abuse

prog

Harding 1980 [36]

Colombia, India, Sudan, Philippines

several primary care health facilities

n.r.

prospectively

1624 patients

♀ 75%

n.r.

IN: attending patients ≥ 16 years

EX: seriously ill (e.g. coma), requiring urgent medical care

pre

Hofmans-Okkes 1993 Dutch Study [37]

Netherlands

6 practices with 10 physicians

n.r.

prospectively

385 RFE

200 consultations

♀ 62%

Ø 40

IN: doctors coded RFE during encounters

pre

Hofmans-Okkes 1993 International Study [37]

Belgium, Denmark, Israel, Italy, Netherlands, Portugal, Spain, UK, USA

22 physicians

01/1990–02/1991

prospectively

943 RFE

497 consultations

♀ 64%

Ø 38

IN: consecutive routine encounters

pre

Hull 1969 [38]

UK

1 rural general practice with 2 GPs

10/1966–02/1967

prospectively

1000 incidental consultations

♀ 54%

n.r.

IN: consecutive new cases presenting in practice

EX: consultations for antenatal, immunization or contraceptive care

pre

Liu 2017 [39]

China

14 community health service centers with 100 GPs in 6 suburban districts of Beijing

12/2014–01/2015

prospectively

10,000 consultations 13,705 RFE

♀ 52,5%

 < 35–55 + 

IN: consecutive patients’ encounters

pre

Martin 1984 [40]

Saudi Arabia

1 primary care department of a hospital serving a military community in Riyadh

n.r.

prospectively

1000 incidental consultations

♀ 42%

0–45 + 

IN: patients presenting for the first time with a problem

pre

Mash 2012 [41]

South Africa

83 primary care clinics, 17 mobile clinics, 12 community health centres; nurse-led with support from doctors

1 year

prospectively

18,856 consultations 31,451 RFE

♀ 66%

 < 1–79

IN: all ambulatory patients seen by the health worker

pre

Molony 2016 [42]

Ireland

1 large general practice with 4 GPs in a primary healthcare centre in North Cork

10/2010–10/2014

retrospectively

5100 patients

52,572 consultations

70,489 RFE

0–80 + 

IN: doctor-patient face-to-face encounters on all working days and 146 non-working days with documentation of diagnostic code

EX: contacts with practice nurse/ practice’s administrative team, telephone or ‘out-of-hours’ contacts

pre

Morrell 1971/1972[43, 44]

UK

1 general practice with 3 GPs

1 year

prospectively

4455 patients

21,098 consultations

5323 new symptoms

♀ 52%

0–65 + 

IN: new patient-initiated consultations with symptoms not presented to any doctor in the previous 12 months

EX: doctor-initiated consultations

pre

aet

Munyati 2005 [45]

Zimbabwe

2 primary health care clinics in Harare

n.r.

prospectively

544 patients

♀ 52%

83% HIV-positive

16–55 + 

Ø 33

IN: patients ≥ 16 years with cough ≥ 3 weeks consulting on weekdays

EX: treatment for tuberculosis; requiring immediate admission to hospital; unwilling to undergo HIV-testing; not resident in region Mbare

aet

NAMCS [46, 47]

USA

general internists, family practioners or general practicioners

1980, 1981, 1985, 1989–1994 resp. 1985–1986

prospectively

3416–183,225 consultations

♀ 59–60%

 < 15–75 + resp.

0–75 + 

IN: visits by patients with a chief complaint of cough during a randomly assigned 1-week reporting period

pre

aet

Nantha 2014 [48]

Malaysia

1 primary health care clinic

01–05/2013

prospectively

151 patients (117 after follow-up)

♀ 49%

18–60 + 

IN: patients > 18 years presenting with a chief complaint of cough > 2 weeks

aet

Njalsson 1992 [49]

Iceland

12 rural and 4 urban primary care health centres

01–12/1988

prospectively

49,193 patients

284,348 RFE

♀ 60%

0–75 + 

IN: all contacts (including prescriptions, follow-up visits, tests, procedures and administrative visits)

pre

Robertson 1991 [50]

USA

1 GP in 1 Family Medicine Unit at the Medical University of South Carolina

07/1976–06/1979

prospectively

304 patients

956 consultations

1377 RFE

0–65 + 

IN: all patient contacts

pre

SESAM 2 Study [51, 52]

Germany

209 GPs in the federal state of Saxony

10/1999–09/2000

prospectively

8877 patients

13,632 RFE

♀56,9%

0–75 + 

IN: randomly selected patients presenting in general practice (tenth consultation of the consultation hour) previously known to the practitioner

EX: house calls, patients already included in SESAM 2 study

pre

aet

Silva 1998 [53]

Sri Lanka

34 general practioners

07/1996

prospectively

2068 consultations

3448 RFE

♀ 53%

 < 12–65 + 

IN: consecutive doctor-patient encounters

pre

Stefanoff 2014 [54]

Poland

34 health units with 78 GPs

07/2009–04/2011

prospectively

158,863 patients

197,955 py

♀ 52%

3–70 + 

IN: patients ≥ 3 years, cough 2–15 weeks

pre

aet

TRANSITION Project [37, 55]

Netherlands resp.

Netherlands, Malta and Serbia

54 family physicians in 23 locations in the Netherlands resp. family physicians in the Netherlands, Malta and Serbia

1985–1995 resp. 1995–2005

prospectively

93,297–274,620 py

236,027 EOC

267,897–337,348 consultations

n.r.

IN: episode data for all face-to-face encounters with their listed patients

pre

aet

Verzantvoort 2018 [56]

Netherlands

users of the smartphone application “Should I see a doctor?” as a self-triage decision tool for acute primary care

07/2014–07/2015

prospectively

4446 app users

3317 patients with registered symptoms

♀ 66%

0–66 + 

IN: app-users who answered to have used the app for a current medical problem

pre

Wong 2016 [57]

China

19 clinicians in Hong Kong public primary care clinics and private clinics

11/2011–02/2014

prospectively

455 patients (321 after follow-up)

♀ 57%

Ø47.1

IN: immunocompetent patients ≥ 18 years consulting within normal consulting hours with an acute or worsened cough (≤ 28 days duration) as main symptom, or clinical presentation that suggested LRTI

prog

Woolnough 1985 [58]

Canada

1 family practice

4 separate months in each season of the year

prospectively

32 patients

♀ 59%

20–70 + 

IN: all patients whose chief presenting reason was cough

aet

Worrall 2008 [59]

Canada

1 community health centre, 1 GP

fall/winter 2005–2006

prospectively

100 patients

1–90

IN: consecutive patients with cough ≤ 14 days

aet

  1. Legend: aet = aetiology of the symptom cough in primary care, EOC = episode of care, n.r. = not reported, pre = prevalence of the symptom cough in primary care, prog = prognosis of the symptom cough in primaryare, py = patient years, resp. = respectively, RFE = reasons for encounter, ♀ = female, Ø = mean