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

Abigail Moore, Anthony Harnden, Cameron C. Grant, Sheena Patel, Richard S. Irwin, CHEST Expert Cough Panel

Research output: Contribution to journalArticleResearchpeer-review

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.

LanguageEnglish
Pages147-154
Number of pages8
JournalChest
Volume155
Issue number1
Early online date12 Oct 2018
DOIs
StatePublished - Jan 2019
Externally publishedYes

Fingerprint

Whooping Cough
Cough
Thorax
Guidelines
Vomiting
Fever
Meta-Analysis
Routine Diagnostic Tests
Sensitivity and Specificity

Cite this

Moore, A., Harnden, A., Grant, C. C., Patel, S., Irwin, R. S., & CHEST Expert Cough Panel (2019). Clinically Diagnosing Pertussis-associated Cough in Adults and Children: Chest Guideline and Expert Panel Report. Chest, 155(1), 147-154. DOI: 10.1016/j.chest.2018.09.027
Moore, Abigail ; Harnden, Anthony ; Grant, Cameron C. ; Patel, Sheena ; Irwin, Richard S. ; CHEST Expert Cough Panel. / Clinically Diagnosing Pertussis-associated Cough in Adults and Children : Chest Guideline and Expert Panel Report. In: Chest. 2019 ; Vol. 155, No. 1. pp. 147-154
@article{54e30c1c80b04bc2b06bc96824c619df,
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.",
author = "Abigail Moore and Anthony Harnden and Grant, {Cameron C.} and Sheena Patel and Irwin, {Richard S.} and {CHEST Expert Cough Panel}",
year = "2019",
month = "1",
doi = "10.1016/j.chest.2018.09.027",
language = "English",
volume = "155",
pages = "147--154",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",

}

Moore, A, Harnden, A, Grant, CC, Patel, S, Irwin, RS & CHEST Expert Cough Panel 2019, 'Clinically Diagnosing Pertussis-associated Cough in Adults and Children: Chest Guideline and Expert Panel Report' Chest, vol. 155, no. 1, pp. 147-154. DOI: 10.1016/j.chest.2018.09.027

Clinically Diagnosing Pertussis-associated Cough in Adults and Children : Chest Guideline and Expert Panel Report. / Moore, Abigail; Harnden, Anthony; Grant, Cameron C.; Patel, Sheena ; Irwin, Richard S.; CHEST Expert Cough Panel.

In: Chest, Vol. 155, No. 1, 01.2019, p. 147-154.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

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

T2 - Chest

AU - Moore,Abigail

AU - Harnden,Anthony

AU - Grant,Cameron C.

AU - Patel,Sheena

AU - Irwin,Richard S.

AU - CHEST Expert Cough Panel,null

PY - 2019/1

Y1 - 2019/1

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.

U2 - 10.1016/j.chest.2018.09.027

DO - 10.1016/j.chest.2018.09.027

M3 - Article

VL - 155

SP - 147

EP - 154

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -

Moore A, Harnden A, Grant CC, Patel S, Irwin RS, CHEST Expert Cough Panel. Clinically Diagnosing Pertussis-associated Cough in Adults and Children: Chest Guideline and Expert Panel Report. Chest. 2019 Jan;155(1):147-154. Available from, DOI: 10.1016/j.chest.2018.09.027