Burden and emergency department management of acute cough in children

Sophie Anderson-James, Julie M. Marchant, Anne B. Chang, Jason P. Acworth, Natalie T. Phillips, Benjamin J. Drescher, Vikas Goyal, Kerry Ann F. O'Grady

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Aim: In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines.

    Methods: This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0–4.0); 61.5% were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, ‘wheeze/reactive airway disease (RAD)’, croup and ‘non-specific acute respiratory illness’.

    Results: A total of 300 children (55.9%) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4%). While 93.4% of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or ‘wheeze/RAD’. The majority of children with a discharge diagnosis of ‘wheeze/RAD’ (95.6%) received bronchodilators, and 72.7% also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1%) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation.

    Conclusions: The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with ‘wheeze/RAD’ suggests asthma is likely under-diagnosed in this setting.

    Original languageEnglish
    Pages (from-to)181-187
    Number of pages7
    JournalJournal of Paediatrics and Child Health
    Volume55
    Issue number2
    Early online date1 Aug 2018
    DOIs
    Publication statusPublished - Feb 2019

    Fingerprint

    Cough
    Hospital Emergency Service
    Croup
    Bronchiolitis
    Asthma
    Guidelines
    Hospitalized Child
    Bronchodilator Agents
    Teaching Hospitals
    Pneumonia
    Adrenal Cortex Hormones
    Chronic Disease
    Cross-Sectional Studies
    Outcome Assessment (Health Care)

    Cite this

    Anderson-James, S., Marchant, J. M., Chang, A. B., Acworth, J. P., Phillips, N. T., Drescher, B. J., ... O'Grady, K. A. F. (2019). Burden and emergency department management of acute cough in children. Journal of Paediatrics and Child Health, 55(2), 181-187. https://doi.org/10.1111/jpc.14146
    Anderson-James, Sophie ; Marchant, Julie M. ; Chang, Anne B. ; Acworth, Jason P. ; Phillips, Natalie T. ; Drescher, Benjamin J. ; Goyal, Vikas ; O'Grady, Kerry Ann F. / Burden and emergency department management of acute cough in children. In: Journal of Paediatrics and Child Health. 2019 ; Vol. 55, No. 2. pp. 181-187.
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    abstract = "Aim: In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines. Methods: This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0–4.0); 61.5{\%} were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, ‘wheeze/reactive airway disease (RAD)’, croup and ‘non-specific acute respiratory illness’. Results: A total of 300 children (55.9{\%}) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4{\%}). While 93.4{\%} of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or ‘wheeze/RAD’. The majority of children with a discharge diagnosis of ‘wheeze/RAD’ (95.6{\%}) received bronchodilators, and 72.7{\%} also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1{\%}) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation. Conclusions: The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with ‘wheeze/RAD’ suggests asthma is likely under-diagnosed in this setting.",
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    Anderson-James, S, Marchant, JM, Chang, AB, Acworth, JP, Phillips, NT, Drescher, BJ, Goyal, V & O'Grady, KAF 2019, 'Burden and emergency department management of acute cough in children', Journal of Paediatrics and Child Health, vol. 55, no. 2, pp. 181-187. https://doi.org/10.1111/jpc.14146

    Burden and emergency department management of acute cough in children. / Anderson-James, Sophie; Marchant, Julie M.; Chang, Anne B.; Acworth, Jason P.; Phillips, Natalie T.; Drescher, Benjamin J.; Goyal, Vikas; O'Grady, Kerry Ann F.

    In: Journal of Paediatrics and Child Health, Vol. 55, No. 2, 02.2019, p. 181-187.

    Research output: Contribution to journalArticleResearchpeer-review

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    Anderson-James S, Marchant JM, Chang AB, Acworth JP, Phillips NT, Drescher BJ et al. Burden and emergency department management of acute cough in children. Journal of Paediatrics and Child Health. 2019 Feb;55(2):181-187. https://doi.org/10.1111/jpc.14146