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Children with chronic cough: when is watchful waiting appropriate? Development of likelihood ratios for assessing children with chronic cough

Chang, Anne B., van Asperen, Peter P., Glasgow, Nicholas, Robertson, Colin F., Mellis, Craig M., Masters, Ian B., Landau, Louis I., Teoh, Laurel, Tjhung, Irene, Petsky, Helen L. and Morris, Peter S. (2015). Children with chronic cough: when is watchful waiting appropriate? Development of likelihood ratios for assessing children with chronic cough. Chest,147(3):745-753.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 6
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IRMA ID 84473293xPUB147
Title Children with chronic cough: when is watchful waiting appropriate? Development of likelihood ratios for assessing children with chronic cough
Author Chang, Anne B.
van Asperen, Peter P.
Glasgow, Nicholas
Robertson, Colin F.
Mellis, Craig M.
Masters, Ian B.
Landau, Louis I.
Teoh, Laurel
Tjhung, Irene
Petsky, Helen L.
Morris, Peter S.
Journal Name Chest
Publication Date 2015
Volume Number 147
Issue Number 3
ISSN 0012-3692   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84924907769
Start Page 745
End Page 753
Total Pages 9
Place of Publication United States
Publisher American College of Chest Physicians
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract BACKGROUND
Chronic cough is associated with poor quality of life and may signify a serious underlying disease. Differentiating nonspecific cough (when watchful waiting can be safely undertaken) from specific cough (treatment and further investigations are beneficial) would be clinically useful. In 326 children, we aimed to (1) determine how well cough pointers (used in guidelines) differentiate specific from nonspecific cough and (2) describe the clinical profile of children whose cough resolved without medications (spontaneous resolution).

METHODS
A dataset from a multicenter study involving children newly referred for chronic cough (median duration, 3-4 months) was used to determine the sensitivity, specificity, predictive values, and likelihood ratios (LRs) of cough pointers (symptoms, signs, and simple investigations [chest radiography, spirometry]) recommended in guidelines.

RESULTS

The pretest probability of specific cough was 88%. The absence of false-positive results meant that most pointers had strongly positive LRs. The most sensitive pointer (wet cough) had a positive LR of 26.2 (95% CI, 3.8-181.5). Although the absence of other individual pointers did not change the pretest probability much (negative LR close to 1), the absence of all pointers had a strongly negative LR of 0 (95% CI, 0-0.03). Children in the resolved spontaneously group were significantly more likely to be older, to be non-Indigenous, and to have a dry cough and a normal chest radiograph.

CONCLUSIONS

Children with chronic dry cough without any cough pointers can be safely managed using the watchful waiting approach. The high pretest probability and high positive LRs of cough pointers support the use of individual cough pointers to identify high risk of specific cough in pediatric chronic cough guidelines.
DOI http://dx.doi.org/10.1378/chest.14-2155   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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