A cough algorithm for chronic cough in children: a multicenter, randomized controlled study
Anne Bernadette Chang1, Colin Francis Robertson, Peter Paul van Asperen
1Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. annechang@ausdoctors.net
Insights
A standardized clinical pathway for pediatric chronic cough significantly improved cough resolution and quality of life in children. Early implementation of this cough algorithm demonstrated superior clinical outcomes compared to delayed use.
Area of Science:
- Pediatric Pulmonology
- Clinical Trial Methodology
- Health Outcomes Research
Background:
- Chronic cough in children is a common and often persistent issue.
- Standardized management pathways can potentially improve care efficiency and effectiveness.
- Evaluating the reliability and validity of such pathways is crucial for clinical adoption.
Purpose of the Study:
- To evaluate if a standardized clinical management pathway improves clinical outcomes for chronic cough in children within 6 weeks.
- To assess the reliability and validity of this standardized pathway for pediatric chronic cough.
Main Methods:
- A pragmatic, multicenter randomized controlled trial involving 272 children with chronic cough.
- Children were allocated to either early or delayed use of a standardized cough algorithm.
- Primary outcomes included cough resolution and cough-specific quality of life at 6 weeks.
Main Results:
- Significantly higher cough resolution rates at 6 weeks in the early-arm group (24.7% absolute risk reduction).
- Improved cough-specific quality of life scores at 6 weeks in the early-arm group.
- Shorter cough duration post-randomization and high reliability (κ = 1) and validity (93%-100%) of the algorithm were observed.
Conclusions:
- Management of pediatric chronic cough using a standardized algorithm improves clinical outcomes.
- The standardized algorithm is reliable, valid, and feasible for primary care settings.
- Further validation of this clinical algorithm in diverse settings is recommended.
Objectives:
The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children.
Methods:
A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm ("early-arm"); or (2) usual care until review and use of cough algorithm ("delayed-arm"). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm's reliability, validity, and feasibility.
Results:
Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13-35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29-1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm's validity (93%-100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care.
Conclusions:
Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.
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