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

¹ Department of Respiratory Medicine, Royal Children’s Hospital, Brisbane, Australia
² School of Medicine, Discipline of Paediatrics and Child Health, University of Queensland, Royal Children’s Hospital, Brisbane, Australia

Correspondence to:
Correspondence to:
Dr J M Marchant
Department of Respiratory Medicine, Royal Children’s Hospital, Herston, 4029, Queensland, Australia; Julie_Marchant{at}health.qld.gov.au

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. A study was undertaken to evaluate (1) whether historical cough pointers can predict which children have a specific cause for their cough and (2) the usefulness of chest radiography and spirometry as standard investigations in children with chronic cough.

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

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

Conclusions: The most useful clinical marker in predicting specific cough is the presence of a daily moist cough. Both chest examination and chest radiographic abnormalities are also useful in predicting whether children have a specific cause of their cough.

Keywords: chronic cough; children; diagnosis

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				J. M. Marchant, P. A. Newcombe, E. F. Juniper, J. K. Sheffield, S. L. Stathis, and A. B. Chang What Is the Burden of Chronic Cough for Families? Chest, August 1, 2008; 134(2): 303 - 309. [Abstract] [Full Text] [PDF]

				D. Donnelly, A. Critchlow, and M. L Everard Outcomes in children treated for persistent bacterial bronchitis Thorax, January 1, 2007; 62(1): 80 - 84. [Abstract] [Full Text] [PDF]

				M D Shields Diagnosing chronic cough in children. Thorax, August 1, 2006; 61(8): 647 - 648. [Full Text] [PDF]