Utility of signs and symptoms of chronic cough in predicting specific cause in childr

[Anil Tuladhar]

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. We evaluated (i) whether historical cough pointers can predict which children have a specific cause for their cough and (ii) the utility of CXR and spirometry as standard investigations in children with chronic cough.

Methods: A prospective cohort study of children referred to a tertiary hospital with >3 weeks cough between June 2002 and July 2004. All included children completed detailed history and examination using a standardized data collection sheet and followed a pathway of investigation until diagnosis was made.

Results: In 100 consecutively recruited children (median age 2.8 years) the best predictor of specific cough was observed moist cough at time of consultation with odds ratio (OR) 9.34 (95%CIs 3.49, 25.03). A chest examination or chest x-ray abnormality were also predictive with OR 3.60 (95% CIs 1.31, 9.90) and OR 3.16 (95% CIs 1.32, 7.62) respectively. The most significant historical pointer for predicting specific cause of the cough was a parental history of moist cough (sensitivity 96%, specificity 26%, positive predictive value 74%).

Conclusions: This is the first study to evaluate the utility of historical and clinical markers in predicting the cause of cough in children and has found the most useful clinical marker in predicting specific cough is the presence of a daily moist cough. Both chest examination and chest x-ray abnormalities are also useful in predicting if children have a specific cause of their cough.