Chest
Original Research: Signs and Symptoms of Chest DiseasesClinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis
Section snippets
Study Selection and Data Extraction
A diagnostic test accuracy protocol was developed by using the relevant Cochrane handbook16 but not formally registered (available on request). We considered as eligible studies those that included patients of any age attending any health-care setting, including pertussis outbreaks, with any clinical characteristic (index test) that might be associated with pertussis, compared with laboratory confirmation of B pertussis (reference standard). All studies with sufficient published or unpublished
Results
Figure 1 shows the flowchart of study selection. A total of 1,969 unique papers were identified; 422 of these had a full-text review. Forty-seven studies met inclusion criteria for this review and contained sufficient data in the published article for complete data extraction. Fourteen additional articles were identified with potential unpublished data. The authors of these articles were contacted, six of whom provided the necessary information. Overall, 53 articles were included in descriptive
Summary of Evidence
Our meta-analysis demonstrates four key characteristics that are important in ruling in or ruling out a clinical diagnosis of pertussis in adults: paroxysmal cough, posttussive vomiting, inspiratory whoop, and absence of fever.
We found that paroxysmal cough and absence of fever in adults have high sensitivity and low specificity. The clinical implication is that if an adult patient does not have paroxysmal cough or does have a fever, they are very unlikely to have pertussis, good “rule out”
Conclusions
There is substantial statistical heterogeneity between all included studies, which reflects heterogeneity in study designs used. As a result, meta-analysis was only possible of a limited number of clinical characteristics, predominantly in adult patients. The results of the meta-analysis showed that recognizing the classical triad of symptoms in adults remains helpful for clinicians. In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of
Acknowledgments
Author contributions: A. M. takes responsibility for the content of the manuscript, including the data and analysis. N. W. R. designed the search strategy and ran and updated the searches. A. M. and H. F. A. screened the abstracts and completed full-text reviews, data extraction, and assessments of quality and bias. A. H. acted as an independent adjudicator for any discrepancies in this process. B. S. completed the statistical analysis. All authors contributed substantially to the study design,
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Cited by (24)
Evaluating the role of cough duration in the pertussis case definition among Michigan cases, 2000–2010
2019, Preventive Medicine ReportsCitation Excerpt :For all probable cases over one year of age, the presence of a confirmatory criterion substantiates, but does not eliminate, the need to meet the clinical case definition. Studies have shown that a cough length of 14 or more days is the most sensitive of the clinical characteristics, although cough attributes (e.g. paroxysms, post-tussive vomiting) have higher specificity (Domínguez et al., 2017; Ebell et al., 2017; Jõgi et al., 2018; Moore et al., 2017). The shifting age epidemiology of pertussis cases, with longer time to treatment (Goodenough et al., 2016), makes it less likely that cases will be laboratory positive, and requires broader utilization of the clinical case definition, thereby improving reporting of probable pertussis cases to better characterize population-level susceptibility.
Response
2019, ChestClinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report
2019, ChestCitation Excerpt :The systematic review followed all the standards of the National Academy of Medicine (previously referred to as the Institute of Medicine).13 After generating the key clinical question for the systematic review, population, index test, reference test, and target condition elements were derived to inform the literature review (Table 3).10 The authors of the review systematically searched the following databases: CINAHL (EBSCHost from 1982 to 2016), Embase (OvidSP from 1974 to 2016), Medline & Medline In-Process (OvidSP from 1946 to 2016), and SCI-EXPANDED/CPCI-S (Web of Science Core Collection from 1945 to 2016).
FUNDING/SUPPORT: B. S. is funded by the National Institute for Health Research Leeds Diagnostic Evidence Co-operative. D. S. L. is funded by the National Institute for Health Research Oxford Biomedical Research Centre.