Can Acute Cough Characteristics From Sound Recordings Differentiate Common Respiratory Illnesses in Children?: A
Nina Bisballe-Müller1, Anne B Chang2, Erin J Plumb3
1Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department for Clinical Research, University of Southern Denmark, Odense, Denmark.
Insights
Cough characteristics like sound and frequency do not reliably distinguish between common childhood respiratory illnesses. Further research is needed to improve diagnosis of acute respiratory infections in children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Acute respiratory illnesses are a significant global health burden in children.
- Cough is a prevalent symptom, but its characteristics are not well-established for differentiating etiologies.
- Limited data exist on using cough features to diagnose common pediatric respiratory conditions.
Purpose of the Study:
- To determine if specific cough characteristics can differentiate between common acute respiratory illnesses in children.
- To investigate the diagnostic utility of cough frequency, sound, and type in pediatric respiratory conditions.
- To compare expert assessment of cough with discharge diagnoses.
Main Methods:
- A cohort of 148 children (hospitalized with asthma, bronchiolitis, pneumonia, other infections, or controls) was studied.
- Digital recordings captured spontaneous coughs over 24 hours; frequency and type (wet/dry) were analyzed.
- Cough characteristics were assessed by blinded observers and compared to discharge diagnoses using statistical agreement measures.
Main Results:
- Overall agreement between specialist diagnosis and discharge diagnosis was slight (Cohen's kappa = 0.13).
- Sensitivity and specificity varied significantly across diagnoses.
- Inter-rater agreement for cough type was high (kappa = 0.89), and objective cough frequency correlated with caregiver reports.
Conclusions:
- Cough characteristics alone are insufficient for accurately differentiating common acute respiratory illnesses in children.
- Clinical assessment of cough requires complementary diagnostic tools for precise etiological diagnosis.
- Further investigation into objective cough analysis may offer improved diagnostic capabilities.
Background:
Acute respiratory illnesses cause substantial morbidity worldwide. Cough is a common symptom in these childhood respiratory illnesses, but no large cohort data are available on whether various cough characteristics can differentiate between these etiologies.
Research Question:
Can various clinically based cough characteristics (frequency [daytime/ nighttime], the sound itself, or type [wet/dry]) be used to differentiate common etiologies (asthma, bronchiolitis, pneumonia, other acute respiratory infections) of acute cough in children?
Study Design And Methods:
Between 2017 and 2019, children aged 2 weeks to ≤16 years, hospitalized with asthma, bronchiolitis, pneumonia, other acute respiratory infections, or control subjects were enrolled. Spontaneous coughs were digitally recorded over 24 hours except for the control subjects, who provided three voluntary coughs. Coughs were extracted and frequency defined (coughs/hour). Cough sounds and type were assessed independently by two observers blinded to the clinical data. Cough scored by a respiratory specialist was compared with discharge diagnosis using agreement (Cohen's kappa coefficient [қ]), sensitivity, and specificity. Caregiver-reported cough scores were related with objective cough frequency using Spearman coefficient (rs).
Results:
A cohort of 148 children (n = 118 with respiratory illnesses, n = 30 control subjects), median age = 2.0 years (interquartile range, 0.7-3.9), 58% males, and 50% First Nations children were enrolled. In those with respiratory illnesses, caregiver-reported cough scores and wet cough (range, 42%-63%) was similar. Overall agreement in diagnosis between the respiratory specialist and discharge diagnosis was slight (қ = 0.13; 95% CI, 0.03 to 0.22). Among diagnoses, specificity (8%-74%) and sensitivity (53%-100%) varied. Interrater agreement in cough type (wet/dry) between blinded observers was almost perfect (қ = 0.89; 95% CI, 0.81 to 0.97). Objective cough frequency was significantly correlated with reported cough scores using visual analog scale (rs = 0.43; bias-corrected 95% CI, 0.25 to 0.56) and verbal categorical description daytime score (rs = 0.39; bias-corrected 95% CI, 0.22 to 0.54).
Interpretation:
Cough characteristics alone are not distinct enough to accurately differentiate between common acute respiratory illnesses in children.
Related Concept Videos
01:28Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
01:31Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:30Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...
01:31Common Respiratory Disorders
Upper respiratory disorders impact the airways above the vocal cords, encompassing areas like the nose, sinuses, and throat. Various conditions fall under this category, including the common cold and allergic rhinitis. These disorders can stem from several causes,...
01:17Pulmonary Cycle: Exhalation