Clinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report

CHEST Expert Cough Panel

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The decision to treat a suspected case of pertussis with antibiotics is usually based on a clinical diagnosis rather than waiting for laboratory confirmation. The current guideline focuses on making the clinical diagnosis of pertussis-associated cough in adults and children. Methods: The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on findings from a systematic review that was recently published on the topic; final grading was reached by consensus according to Delphi methodology. The systematic review was carried out to answer the Key Clinical Question: In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough? Results: In adults, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 4 clinical features: paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever. Both paroxysmal cough and absence of fever had high sensitivity (93.2% [95% CI, 83.2-97.4] and 81.8% [95% CI, 72.2-88.7], respectively) and low specificity (20.6% [95% CI, 14.7-28.1] and 18.8% [95% CI, 8.1-37.9]). Inspiratory whooping and posttussive vomiting had a low sensitivity (32.5% [95% CI, 24.5-41.6] and 29.8% [95% CI, 18.0-45.2]) but high specificity (77.7% [95% CI, 73.1-81.7] and 79.5% [95% CI, 69.4-86.9]). In children, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 1 clinical feature in children (0-18 years): posttussive vomiting. Posttussive vomiting in children was only moderately sensitive (60.0% [95% CI, 40.3-77.0]) and specific (66.0% [95% CI, 52.5-77.3]). Conclusions: In adults with acute (< 3 weeks) or subacute (3-8 weeks) cough, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children with acute (< 4 weeks) cough, posttussive vomiting is suggestive of pertussis but is much less helpful as a clinical diagnostic test. Guideline suggestions are made based upon these findings and conclusions.

Original languageEnglish (US)
Pages (from-to)147-154
Number of pages8
JournalChest
Volume155
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Whooping Cough
Cough
Guidelines
Vomiting
Fever
Meta-Analysis
Sensitivity and Specificity
Routine Diagnostic Tests
Anti-Bacterial Agents

Keywords

  • cough
  • evidence-based medicine
  • guidelines
  • infectious disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Clinically Diagnosing Pertussis-associated Cough in Adults and Children : CHEST Guideline and Expert Panel Report. / CHEST Expert Cough Panel.

In: Chest, Vol. 155, No. 1, 01.01.2019, p. 147-154.

Research output: Contribution to journalArticle

@article{45d69873dac54600a4361ca84b55496a,
title = "Clinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report",
abstract = "Background: The decision to treat a suspected case of pertussis with antibiotics is usually based on a clinical diagnosis rather than waiting for laboratory confirmation. The current guideline focuses on making the clinical diagnosis of pertussis-associated cough in adults and children. Methods: The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on findings from a systematic review that was recently published on the topic; final grading was reached by consensus according to Delphi methodology. The systematic review was carried out to answer the Key Clinical Question: In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough? Results: In adults, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 4 clinical features: paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever. Both paroxysmal cough and absence of fever had high sensitivity (93.2{\%} [95{\%} CI, 83.2-97.4] and 81.8{\%} [95{\%} CI, 72.2-88.7], respectively) and low specificity (20.6{\%} [95{\%} CI, 14.7-28.1] and 18.8{\%} [95{\%} CI, 8.1-37.9]). Inspiratory whooping and posttussive vomiting had a low sensitivity (32.5{\%} [95{\%} CI, 24.5-41.6] and 29.8{\%} [95{\%} CI, 18.0-45.2]) but high specificity (77.7{\%} [95{\%} CI, 73.1-81.7] and 79.5{\%} [95{\%} CI, 69.4-86.9]). In children, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 1 clinical feature in children (0-18 years): posttussive vomiting. Posttussive vomiting in children was only moderately sensitive (60.0{\%} [95{\%} CI, 40.3-77.0]) and specific (66.0{\%} [95{\%} CI, 52.5-77.3]). Conclusions: In adults with acute (< 3 weeks) or subacute (3-8 weeks) cough, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children with acute (< 4 weeks) cough, posttussive vomiting is suggestive of pertussis but is much less helpful as a clinical diagnostic test. Guideline suggestions are made based upon these findings and conclusions.",
keywords = "cough, evidence-based medicine, guidelines, infectious disease",
author = "{CHEST Expert Cough Panel} and Abigail Moore and Anthony Harnden and Grant, {Cameron C.} and Sheena Patel and Irwin, {Richard S.} and Altman, {Kenneth W.} and Elie Azoulay and Alan Barker and Bolser, {Donald C.} and Birring, {Surinder S.} and Fiona Blackwell and Boulet, {Louis Philippe} and Braman, {Sidney S.} and Christopher Brightling and Priscilla Callahan-Lyon and Chang, {Anne B.} and Terrie Cowley and Paul Davenport and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Cameron Grant and Peter Gibson and Philip Gold and Harding, {Susan M.} and Anthony Harnden and Hill, {Adam T.} and Irwin, {Richard S.} and Kahrilas, {Peter J.} and Joanne Kavanagh and Keogh, {Karina A.} and Kefang Lai and Lane, {Andrew P.} and Kaiser Lim and Mark Lown and Madison, {J. Mark} and Malesker, {Mark A.} and Stuart Mazzone and Lorcan McGarvey and Alex Molasoitis and Abigail Moore and Murad, {M. Hassan} and Mangala Narasimhan and Peter Newcombe and Nguyen, {Huong Q.} and John Oppenheimer and Mark Rosen and Bruce Rubin",
year = "2019",
month = "1",
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language = "English (US)",
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pages = "147--154",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
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TY - JOUR

T1 - Clinically Diagnosing Pertussis-associated Cough in Adults and Children

T2 - CHEST Guideline and Expert Panel Report

AU - CHEST Expert Cough Panel

AU - Moore, Abigail

AU - Harnden, Anthony

AU - Grant, Cameron C.

AU - Patel, Sheena

AU - Irwin, Richard S.

AU - Altman, Kenneth W.

AU - Azoulay, Elie

AU - Barker, Alan

AU - Bolser, Donald C.

AU - Birring, Surinder S.

AU - Blackwell, Fiona

AU - Boulet, Louis Philippe

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Chang, Anne B.

AU - Cowley, Terrie

AU - Davenport, Paul

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Grant, Cameron

AU - Gibson, Peter

AU - Gold, Philip

AU - Harding, Susan M.

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Irwin, Richard S.

AU - Kahrilas, Peter J.

AU - Kavanagh, Joanne

AU - Keogh, Karina A.

AU - Lai, Kefang

AU - Lane, Andrew P.

AU - Lim, Kaiser

AU - Lown, Mark

AU - Madison, J. Mark

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - McGarvey, Lorcan

AU - Molasoitis, Alex

AU - Moore, Abigail

AU - Murad, M. Hassan

AU - Narasimhan, Mangala

AU - Newcombe, Peter

AU - Nguyen, Huong Q.

AU - Oppenheimer, John

AU - Rosen, Mark

AU - Rubin, Bruce

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The decision to treat a suspected case of pertussis with antibiotics is usually based on a clinical diagnosis rather than waiting for laboratory confirmation. The current guideline focuses on making the clinical diagnosis of pertussis-associated cough in adults and children. Methods: The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on findings from a systematic review that was recently published on the topic; final grading was reached by consensus according to Delphi methodology. The systematic review was carried out to answer the Key Clinical Question: In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough? Results: In adults, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 4 clinical features: paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever. Both paroxysmal cough and absence of fever had high sensitivity (93.2% [95% CI, 83.2-97.4] and 81.8% [95% CI, 72.2-88.7], respectively) and low specificity (20.6% [95% CI, 14.7-28.1] and 18.8% [95% CI, 8.1-37.9]). Inspiratory whooping and posttussive vomiting had a low sensitivity (32.5% [95% CI, 24.5-41.6] and 29.8% [95% CI, 18.0-45.2]) but high specificity (77.7% [95% CI, 73.1-81.7] and 79.5% [95% CI, 69.4-86.9]). In children, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 1 clinical feature in children (0-18 years): posttussive vomiting. Posttussive vomiting in children was only moderately sensitive (60.0% [95% CI, 40.3-77.0]) and specific (66.0% [95% CI, 52.5-77.3]). Conclusions: In adults with acute (< 3 weeks) or subacute (3-8 weeks) cough, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children with acute (< 4 weeks) cough, posttussive vomiting is suggestive of pertussis but is much less helpful as a clinical diagnostic test. Guideline suggestions are made based upon these findings and conclusions.

AB - Background: The decision to treat a suspected case of pertussis with antibiotics is usually based on a clinical diagnosis rather than waiting for laboratory confirmation. The current guideline focuses on making the clinical diagnosis of pertussis-associated cough in adults and children. Methods: The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on findings from a systematic review that was recently published on the topic; final grading was reached by consensus according to Delphi methodology. The systematic review was carried out to answer the Key Clinical Question: In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough? Results: In adults, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 4 clinical features: paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever. Both paroxysmal cough and absence of fever had high sensitivity (93.2% [95% CI, 83.2-97.4] and 81.8% [95% CI, 72.2-88.7], respectively) and low specificity (20.6% [95% CI, 14.7-28.1] and 18.8% [95% CI, 8.1-37.9]). Inspiratory whooping and posttussive vomiting had a low sensitivity (32.5% [95% CI, 24.5-41.6] and 29.8% [95% CI, 18.0-45.2]) but high specificity (77.7% [95% CI, 73.1-81.7] and 79.5% [95% CI, 69.4-86.9]). In children, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 1 clinical feature in children (0-18 years): posttussive vomiting. Posttussive vomiting in children was only moderately sensitive (60.0% [95% CI, 40.3-77.0]) and specific (66.0% [95% CI, 52.5-77.3]). Conclusions: In adults with acute (< 3 weeks) or subacute (3-8 weeks) cough, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children with acute (< 4 weeks) cough, posttussive vomiting is suggestive of pertussis but is much less helpful as a clinical diagnostic test. Guideline suggestions are made based upon these findings and conclusions.

KW - cough

KW - evidence-based medicine

KW - guidelines

KW - infectious disease

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