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Typical RSV cough: myth or reality? A diagnostic accuracy study
Mirjam Binnekamp1,2, Karlijn J van Stralen2, Larissa den Boer2
1Department of Pediatrics, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
Insights
Senior healthcare professionals and nurses can identify respiratory syncytial virus (RSV) in infants by cough sound, but cannot reliably distinguish it from other viruses. Residents require extensive experience for accurate RSV diagnosis.
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.
Abstract:
Respiratory syncytial virus (RSV) is well known for causing a potentially severe course of bronchiolitis in infants. Many paediatric healthcare workers claim to be able to diagnose RSV based on cough sound, which was evaluated in this study. Parents of children < 1 year old admitted to the paediatric ward because of airway complaints were asked to record cough sounds of their child. In all children, MLPA analysis-a variation of PCR analysis-on nasopharyngeal swab was performed (golden standard). Sixteen cough fragments representing 4 different viral pathogens were selected and presented to paediatric healthcare workers. Thirty-two paediatric nurses, 16 residents and 16 senior staff members were asked to classify the audio files and state whether the cough was due to RSV infection or not. Senior staff, nurses and residents correctly identified RSV with a sensitivity of 76.2%, 73.1% and 51.3% respectively. Correct exclusion of RSV cases was performed with a specificity of 60.8%, 60.2% and 65.3% respectively. Sensitivity ranged from 0 to 100% between colleagues; no one correctly identified all negatives. Residents had significantly lower rates of sensitivity than senior staff and nurses. This was strongly related to work experience, in which more than 3.5 years of work experience was related to the best result.Conclusion: Senior staff and nurses were better in making a cough-based diagnosis of RSV compared to residents. Both groups were able to detect the same proportion of true RSV patients based on cough sounds compared to bedside tests but could not validly distinguish RSV from other pathogens based on cough sounds. What is Known: • Many paediatric healthcare workers claim to be capable of diagnosing RSV in infants based on cough sound • Up to now, no studies investigating the recognisability of RSV based on cough sound are published What is New: • Senior staff and paediatric nurses performed better than various other bedside tests in diagnosing RSV but could not replace MLPA analysis • Residents need at least 3.5 years of work experience to be able to make a RSV diagnosis based on cough sound.
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