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Original Research: Signs and Symptoms of Chest Diseases |

Children With Chronic CoughCough Predictors: When Is Watchful Waiting Appropriate? Development of Likelihood Ratios for Assessing Children With Chronic Cough

Anne B. Chang, PhD; Peter P. Van Asperen, MD; Nicholas Glasgow, MD; Colin F. Robertson, MD; Craig M. Mellis, MD; I. Brent Masters, PhD; Louis I. Landau, MD; Laurel Teoh, MD; Irene Tjhung, MD; Helen L. Petsky, PhD; Peter S. Morris, PhD
Author and Funding Information

From the Child Health Division (Drs Chang, Teoh, Tjhung, and Morris), Menzies School of Health Research, Charles Darwin University, Darwin, NT; Queensland Children’s Respiratory Centre (Drs Chang, Masters, and Petsky), Queensland Children’s Medical Research Institute, Royal Children’s Hospital, Brisbane, QLD; Discipline of Paediatrics and Child Health (Dr Van Asperen), Sydney Medical School, and Central Clinical School (Dr Mellis), University of Sydney, Sydney, NSW; Department of Respiratory Medicine (Dr Van Asperen), The Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Westmead, NSW; Medical School (Dr Glasgow), Australian National University, Canberra, ACT; Department of Respiratory Medicine (Dr Robertson), Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC; Medical Workforce (Dr Landau), Health Department of Western Australia and The University of Western Australia, Perth, WA; The Canberra Hospital (Dr Teoh), Canberra, ACT; and Thursday Island Primary Health Care Centre (Dr Tjhung), Thursday Island, QLD, Australia.

CORRESPONDENCE TO: Anne B. Chang, PhD, Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Herston, QLD 4029, Australia; e-mail: annechang@ausdoctors.net


FUNDING/SUPPORT: The study was funded by an Australian National Health and Medical Research Council (NHMRC) [Project Grant 490321] and supported by an NHMRC Centre for Research Excellence in Lung Health of Aboriginal and Torres Strait Islander Children [Grant 1040830]. Dr Chang is supported by an NHMRC practitioner fellowship [Grant 1058213].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):745-753. doi:10.1378/chest.14-2155
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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.

TRIAL REGISTRY:  Australian New Zealand Clinical Trials Registry; No.: 12607000526471; URL: www.anzctr.org.au


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