Marchant J M, Masters I B, Taylor S M, Chang A B
Department of Respiratory Medicine, Royal Children's Hospital, Australia.
Thorax. 2006 Aug;61(8):694-8. doi: 10.1136/thx.2005.056986. Epub 2006 May 2.
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.
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.
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%).
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.
儿科医生依靠咳嗽特征来指导对慢性咳嗽患儿所需的检查水平，但缺乏已发表的数据支持这种方法。本研究旨在评估：（1）既往咳嗽特征是否能预测哪些儿童的咳嗽有特定病因；（2）胸部X光检查和肺功能测定作为慢性咳嗽患儿标准检查的有用性。
这是一项前瞻性队列研究，研究对象为2002年6月至2004年7月转诊至一家三级医院、咳嗽持续超过3周的儿童。所有纳入的儿童使用标准化数据收集表完成详细的病史采集和检查，并遵循检查流程直至做出诊断。
在连续招募的100名中位年龄为2.8岁的儿童中，观察到的特定咳嗽的最佳预测因素是就诊时出现湿性咳嗽，优势比（OR）为9.34（95%可信区间3.49至25.03）。胸部检查或胸部X光异常也具有预测性，OR分别为3.60（95%可信区间1.31至9.90）和3.16（95%可信区间1.32至7.62）。预测咳嗽特定病因的最重要的既往特征是父母有湿性咳嗽史（敏感性96%，特异性26%，阳性预测值74%）。
预测特定咳嗽最有用的临床指标是每日出现湿性咳嗽。胸部检查和胸部X光异常在预测儿童咳嗽是否有特定病因方面也很有用。
