Typical RSV cough: myth or reality? A diagnostic accuracy study.

Area of Science:

• Pediatric Infectious Diseases
• Respiratory Medicine
• Diagnostic Accuracy Studies

Background:

• Respiratory syncytial virus (RSV) commonly causes severe bronchiolitis in infants.
• Healthcare professionals often claim expertise in diagnosing RSV solely by cough sound.
• Limited research exists on the diagnostic capability of cough sounds for RSV.

Purpose of the Study:

• To evaluate the ability of pediatric healthcare workers to diagnose RSV based on infant cough sounds.
• To compare diagnostic accuracy of cough sounds with molecular analysis (MLPA).
• To assess the influence of experience on diagnostic performance.

Main Methods:

• Parents recorded cough sounds from infants (<1 year) admitted with airway complaints.
• MLPA analysis of nasopharyngeal swabs served as the gold standard for RSV detection.
• Paediatric nurses, residents, and senior staff listened to cough audio fragments and classified them for RSV presence.

Main Results:

• Senior staff (76.2%) and nurses (73.1%) showed higher sensitivity in identifying RSV via cough sounds compared to residents (51.3%).
• Specificity for RSV exclusion was moderate across all groups (60.2%–65.3%).
• Diagnostic accuracy correlated with work experience; over 3.5 years of experience yielded the best results for residents.

Conclusions:

• Experienced senior staff and nurses demonstrate moderate accuracy in diagnosing RSV by cough sound, outperforming residents.
• Cough sound analysis alone cannot reliably differentiate RSV from other viral respiratory pathogens.
• While useful for initial assessment, cough sound diagnosis does not replace molecular testing like MLPA for definitive RSV identification.