从录音中能否分辨出儿童常见呼吸道疾病的急性咳嗽特征？一项比较性前瞻性研究。

Can Acute Cough Characteristics From Sound Recordings Differentiate Common Respiratory Illnesses in Children?: A Comparative Prospective Study.

机构信息

Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department for Clinical Research, University of Southern Denmark, Odense, Denmark.

Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.

出版信息

Chest. 2021 Jan;159(1):259-269. doi: 10.1016/j.chest.2020.06.067. Epub 2020 Jul 9.

DOI:10.1016/j.chest.2020.06.067

PMID:32653569

Abstract

BACKGROUND

Acute respiratory illnesses cause substantial morbidity worldwide. Cough is a common symptom in these childhood respiratory illnesses, but no large cohort data are available on whether various cough characteristics can differentiate between these etiologies.

RESEARCH QUESTION

Can various clinically based cough characteristics (frequency [daytime/ nighttime], the sound itself, or type [wet/dry]) be used to differentiate common etiologies (asthma, bronchiolitis, pneumonia, other acute respiratory infections) of acute cough in children?

STUDY DESIGN AND METHODS

Between 2017 and 2019, children aged 2 weeks to ≤16 years, hospitalized with asthma, bronchiolitis, pneumonia, other acute respiratory infections, or control subjects were enrolled. Spontaneous coughs were digitally recorded over 24 hours except for the control subjects, who provided three voluntary coughs. Coughs were extracted and frequency defined (coughs/hour). Cough sounds and type were assessed independently by two observers blinded to the clinical data. Cough scored by a respiratory specialist was compared with discharge diagnosis using agreement (Cohen's kappa coefficient [қ]), sensitivity, and specificity. Caregiver-reported cough scores were related with objective cough frequency using Spearman coefficient (r).

RESULTS

A cohort of 148 children (n = 118 with respiratory illnesses, n = 30 control subjects), median age = 2.0 years (interquartile range, 0.7-3.9), 58% males, and 50% First Nations children were enrolled. In those with respiratory illnesses, caregiver-reported cough scores and wet cough (range, 42%-63%) was similar. Overall agreement in diagnosis between the respiratory specialist and discharge diagnosis was slight (қ = 0.13; 95% CI, 0.03 to 0.22). Among diagnoses, specificity (8%-74%) and sensitivity (53%-100%) varied. Interrater agreement in cough type (wet/dry) between blinded observers was almost perfect (қ = 0.89; 95% CI, 0.81 to 0.97). Objective cough frequency was significantly correlated with reported cough scores using visual analog scale (r = 0.43; bias-corrected 95% CI, 0.25 to 0.56) and verbal categorical description daytime score (r = 0.39; bias-corrected 95% CI, 0.22 to 0.54).

INTERPRETATION

Cough characteristics alone are not distinct enough to accurately differentiate between common acute respiratory illnesses in children.

摘要

背景

急性呼吸道疾病在全球范围内导致大量发病。咳嗽是这些儿童呼吸道疾病的常见症状，但尚无大样本队列数据可用于区分这些病因的各种咳嗽特征。

研究问题

各种基于临床的咳嗽特征（频率[白天/夜间]、声音本身或类型[湿/干]）能否用于区分儿童急性咳嗽的常见病因（哮喘、细支气管炎、肺炎、其他急性呼吸道感染）？

研究设计和方法

在 2017 年至 2019 年间，招募了年龄在 2 周至≤16 岁、因哮喘、细支气管炎、肺炎、其他急性呼吸道感染住院或作为对照的儿童。除对照组外，所有儿童均连续 24 小时记录自然咳嗽，对照组提供三次自愿咳嗽。咳嗽被提取并定义为频率（每小时咳嗽次数）。两名观察者独立评估咳嗽声音和类型，他们对临床数据不知情。使用一致性（科恩氏κ系数[қ]）、敏感性和特异性比较呼吸专家评估的咳嗽评分与出院诊断。使用 Spearman 系数（r）将护理人员报告的咳嗽评分与客观咳嗽频率相关联。

结果

共纳入 148 名儿童（n=118 名患有呼吸道疾病，n=30 名对照组），中位年龄为 2.0 岁（四分位距，0.7-3.9），58%为男性，50%为第一民族儿童。在患有呼吸道疾病的儿童中，护理人员报告的咳嗽评分和湿咳（范围为 42%-63%）相似。呼吸专家与出院诊断之间的整体诊断一致性为轻度（қ=0.13；95%置信区间，0.03 至 0.22）。在各种诊断中，特异性（8%-74%）和敏感性（53%-100%）各不相同。两名观察者之间咳嗽类型（湿/干）的一致性近乎完美（қ=0.89；95%置信区间，0.81 至 0.97）。客观咳嗽频率与使用视觉模拟量表报告的咳嗽评分显著相关（r=0.43；偏倚校正的 95%置信区间，0.25 至 0.56）和口头分类描述白天评分（r=0.39；偏倚校正的 95%置信区间，0.22 至 0.54）。