Utility of signs and symptoms of chronic cough in predicting specific cause in children

Julie M Marchant ^1*, I Brent Masters ¹, Simone M Taylor ¹ and Anne B Chang ¹

¹ Royal Children's Hospital, Brisbane, Australia

^* To whom correspondence should be addressed. E-mail: julie_marchant{at}health.qld.gov.au.

Accepted 20 April 2006

Abstract

Background: Paediatricians rely on cough descriptors to direct them to the level of investigations needed for a child presenting with chronic cough yet there is a lack of published data to support this approach. We evaluated (i) whether historical cough pointers can predict which children have a specific cause for their cough and (ii) the utility of CXR and spirometry as standard investigations in children with chronic cough.

Methods: A prospective cohort study of children referred to a tertiary hospital with >3 weeks cough between June 2002 and July 2004. All included children completed detailed history and examination using a standardized data collection sheet and followed a pathway of investigation until diagnosis was made.

Results: In 100 consecutively recruited children (median age 2.8 years) the best predictor of specific cough was observed moist cough at time of consultation with odds ratio (OR) 9.34 (95%CIs 3.49, 25.03). A chest examination or chest x-ray abnormality were also predictive with OR 3.60 (95% CIs 1.31, 9.90) and OR 3.16 (95% CIs 1.32, 7.62) respectively. The most significant historical pointer for predicting specific cause of the cough was a parental history of moist cough (sensitivity 96%, specificity 26%, positive predictive value 74%).

Conclusions: This is the first study to evaluate the utility of historical and clinical markers in predicting the cause of cough in children and has found the most useful clinical marker in predicting specific cough is the presence of a daily moist cough. Both chest examination and chest x-ray abnormalities are also useful in predicting if children have a specific cause of their cough.

Keywords: chronic cough, diagnosis, investigation, paediatrics, signs and symptoms, respiratory

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Airwaves

Wisia Wedzicha
Thorax 2006 61: 643. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Khoshoo, V., Edell, D., Mohnot, S., Haydel, R. Jr, Saturno, E., Kobernick, A. (2009). Associated Factors in Children With Chronic Cough. Chest 136: 811-815 [Abstract] [Full Text]  
• Bush, A. (2009). Update in Pediatric Lung Disease 2008. Am. J. Respir. Crit. Care Med. 179: 637-649 [Full Text]  
• Chang, A. B. (2008). American College of Chest Physicians Cough Guidelines for Children: Can Its Use Improve Outcomes?. Chest 134: 1111-1112 [Full Text]  
• Marchant, J. M., Newcombe, P. A., Juniper, E. F., Sheffield, J. K., Stathis, S. L., Chang, A. B. (2008). What Is the Burden of Chronic Cough for Families?. Chest 134: 303-309 [Abstract] [Full Text]  
• Donnelly, D., Critchlow, A., Everard, M. L (2007). Outcomes in children treated for persistent bacterial bronchitis. Thorax 62: 80-84 [Abstract] [Full Text]  
• Shields, M D (2006). Diagnosing chronic cough in children.. Thorax 61: 647-648 [Full Text]