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Original Research |

Clinical characteristics of pertussis-associated cough in adults and children: a diagnostic systematic review and meta-analysis

Abigail Moore, BM BCh; Helen F. Ashdown, MRCP MRCGP; Bethany Shinkins, DPhil; Nia W. Roberts, MSc (Econ); Cameron C. Grant, PhD; Daniel S. Lasserson, MD; Anthony Harnden, FRCGP
Author and Funding Information

Guarantor statement:

Abigail Moore takes responsibility for the content of the manuscript, including the data and analysis.

Author contributions:

All authors contributed substantially to the study design, data interpretation, and the writing of the manuscript.

NR designed the search strategy and ran and updated the searches.

AM and HFA screened the abstracts, completed full text reviews, data extraction and assessments of quality and bias. AH acted as an independent adjudicator for any discrepancies in this process.

BS completed the statistical analysis.

Conflicts of interest:

None to declare.

Funding information:

BS is funded by the National Institute for Health Research (NIHR) Leeds Diagnostic Evidence Co-operative.

DSL is funded by the NIHR Oxford Biomedical Research Centre.

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the above centres, NIHR, NHS or the Department of Health.

University of Oxford

University of Oxford

University of Leeds

University of Oxford

University of Auckland

University of Oxford

University of Oxford

Corresponding author: Abigail Moore, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford. OX2 6GG.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.186
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Abstract

Background  Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping and post-tussive vomiting but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough.

Methods  We systematically searched CINAHL, Embase, Medline and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations. Two authors independently completed screening, data extraction and quality and bias assessments. For each characteristic RevMan was used to produce descriptive forest plots. We used the bivariate meta-analysis method to generate pooled estimates of sensitivity and specificity.

Results  Of 1969 identified papers, 53 were included. Forty-one clinical characteristics were assessed for diagnostic accuracy. In adult patients, paroxysmal cough and absence of fever had a high sensitivity (93.2%, CI 83.2-97.4 and 81.8%, CI 72.2-88.7 respectively) and low specificity (20.6%, CI 14.7-28.1 and 18.8%, CI 8.1-37.9 respectively), whereas post-tussive vomiting and whooping had low sensitivity (32.5%, CI 24.5-41.6 and 29.8%, CI 8.0-45.2 respectively) and high specificity (77.7%, CI 73.1-81.7 and 79.5%, CI 69.4-86.9 respectively). Post-tussive vomiting in children is moderately sensitive (60.0%, CI 40.3-77.0) and specific 66.0%, CI 52.5-77.3).

Conclusions  In adult patients the presence of whooping or post-tussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, post-tussive vomiting is much less helpful as a clinical diagnostic test.


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