Clinical pathways for chronic cough in children

Area of Science:

• Pediatric Pulmonology
• Evidence-Based Medicine
• Clinical Pathway Implementation

Background:

• Chronic cough in children is a prevalent issue with significant distress and potential for delayed diagnosis of serious respiratory conditions.
• Clinical guidelines and pathways are crucial for effective management, yet specific pediatric pathways are needed due to differences from adult conditions.
• Systematic evaluation of evidence-based clinical pathways for pediatric chronic cough management is beneficial for clinical practice and patient care.

Purpose of the Study:

• To evaluate the effectiveness of utilizing a clinical pathway in managing children diagnosed with chronic cough.
• To assess the impact of a structured management algorithm on clinical outcomes for pediatric chronic cough.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted, searching databases including CENTRAL, Cochrane Airways Group Register, MEDLINE, and EMBASE up to January 2014.
• Included were parallel-group RCTs comparing the use versus non-use of a clinical pathway for treating chronic cough in individuals under 18 years of age.
• Data extraction and study selection were performed independently by two review authors according to predetermined inclusion criteria.

Main Results:

• One multi-center RCT involving 272 children with chronic cough was included. Children were randomized to early (2 weeks) or delayed (6 weeks) referral to respiratory specialists using a cough management pathway.
• Early pathway referral significantly reduced clinical failure at six weeks (OR 0.35, 95% CI 0.21 to 0.58), with an NNTB of 5 for additional benefit.
• The early pathway group showed significantly better cough-specific parent-reported quality of life scores (MD 0.60, 95% CI 0.19 to 1.01) and a shorter duration of cough post-randomization (MD -2.70 weeks, 95% CI -4.26 to -1.14).

Conclusions:

• Current evidence indicates that employing a clinical algorithm for managing pediatric chronic cough in hospital outpatient settings is more effective than standard wait-list care.
• Further high-quality randomized controlled trials are recommended to evaluate cough management pathways in primary care settings, such as general practice.