Chang Anne B, Van Asperen Peter P, Glasgow Nicholas, Robertson Colin F, Mellis Craig M, Masters I Brent, Landau Louis I, Teoh Laurel, Tjhung Irene, Petsky Helen L, Morris Peter S
Child Health Division, Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD.
Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW.
Chest. 2015 Mar;147(3):745-753. doi: 10.1378/chest.14-2155.
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).
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.
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.
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.
Australian New Zealand Clinical Trials Registry; No.: 12607000526471; URL: www.anzctr.org.au.
慢性咳嗽与生活质量差相关，可能预示着严重的潜在疾病。区分非特异性咳嗽（可安全地进行观察等待）和特异性咳嗽（治疗及进一步检查有益）在临床上具有重要意义。在326名儿童中，我们旨在：（1）确定咳嗽指标（指南中使用的）区分特异性咳嗽和非特异性咳嗽的能力；（2）描述咳嗽未经药物治疗而缓解（自然缓解）的儿童的临床特征。
使用来自一项多中心研究的数据集，该研究涉及新转诊的慢性咳嗽儿童（中位病程3 - 4个月），以确定指南中推荐的咳嗽指标（症状、体征和简单检查[胸部X线摄影、肺功能测定]）的敏感性、特异性、预测值和似然比（LRs）。
特异性咳嗽的预检概率为88%。无假阳性结果意味着大多数指标的LRs为强阳性。最敏感的指标（湿性咳嗽）的阳性LR为26.2（95%CI，3.8 - 181.5）。虽然其他单个指标的缺失对预检概率影响不大（阴性LR接近1），但所有指标均缺失时的阴性LR为强阴性，为0（95%CI，0 - 0.03）。自然缓解组的儿童年龄较大、非原住民、干咳且胸部X线摄影正常的可能性显著更高。
对于无任何咳嗽指标的慢性干咳儿童，可采用观察等待方法进行安全管理。咳嗽指标的高预检概率和高阳性LRs支持在儿科慢性咳嗽指南中使用单个咳嗽指标来识别特异性咳嗽的高风险。
澳大利亚新西兰临床试验注册中心；编号：12607000526471；网址：www.anzctr.org.au。
