Predicting pertussis in a pediatric emergency department population
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Published on: February 22, 2019
Jennifer E Mackey1, Susan Wojcik, Ray Long
1The Department of Emergency Medicine, University of New York Upstate Medical University, Syracuse, NY 13210, USA. mackeyj@upstate.edu
Insights
Pertussis (whooping cough) is surging in infants. Infants under 2 months with specific cough, choking, cyanosis, and rhonchi symptoms are highly likely to have pertussis.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Pertussis (whooping cough) is a serious respiratory illness with cases at a 40-year high, particularly affecting infants.
- Pediatric emergency departments are common sites for initial pertussis evaluation.
- Early recognition is crucial for rapid triage, isolation, and preventing hospital-acquired (nosocomial) transmission.
Purpose of the Study:
- To identify key clinical predictors of pertussis in pediatric emergency department patients.
- To enable prompt identification and isolation of infants with pertussis to prevent transmission.
Main Methods:
- Retrospective, case-control chart review of pediatric patients (0-18 years) presenting to the emergency department.
- Analysis of medical history and physical examination variables to predict pertussis, confirmed by laboratory testing.
Main Results:
- Infants younger than 2 months presenting with cough or choking, cyanosis, and rhonchi on examination showed a high likelihood of pertussis.
- These specific clinical signs are strong predictors for pertussis in young infants.
Conclusions:
- Prompt identification of pertussis in infants under 2 months presenting with specific symptoms is critical in the emergency department.
- Immediate isolation and testing of these infants can lead to timely treatment and reduce nosocomial transmission within the department.
Abstract:
Cases of pertussis, a potentially life-threatening illness in infants younger than 6 months of age, are at a 40-year high. Children frequently present to emergency departments for initial evaluation. Quick recognition of the illness allows rapid triage, isolation, and prevention of nosocomial transmission. A retrospective, case-control chart review was conducted of pediatric emergency department patients (0 to 18 years of age) presenting between January 1, 2003, and December 31, 2004. Analysis focused on the exploration of medical history and physical examination variables as predictors using laboratory verification of the presence of pertussis as a binary outcome variable. Infants younger than 2 months who have a cough or choking associated with cyanosis, as well as a cough and rhonchi on physical examination, have a high likelihood of pertussis and should be identified in triage, isolated immediately, and tested for pertussis. This may lead to appropriate therapy for this population and decrease the transmission of pertussis to other patients and staff in the pediatric emergency department.
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