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A retrospective study on pediatric pertussis: comprehensive evaluation of symptoms, laboratory indicators, and
Junfei Guo1, Weiming Lai1, Qiongdan Mai1
1Department of Clinical Laboratory, Guangdong Women and Children Hospital, Guangzhou, China.
Insights
Pediatric pertussis (whooping cough) epidemiology shifted to older children. Elevated neutrophil counts predict ICU admission, aiding early risk stratification for pertussis in children.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Clinical Diagnostics
Background:
- Pertussis (whooping cough) remains a significant public health concern in children.
- Understanding its evolving epidemiology and improving diagnostic accuracy are crucial for effective management.
- Identifying risk factors for severe outcomes, such as intensive care unit (ICU) admission, is essential.
Purpose of the Study:
- To characterize the epidemiology of pertussis in children.
- To evaluate diagnostic performance of clinical and laboratory features.
- To assess suspected-case criteria and identify ICU admission risk factors.
Main Methods:
- Retrospective analysis of demographic, clinical, and laboratory data from children (≤14 years) tested for pertussis.
- Stratification by test results, calculation of sensitivity/specificity for symptoms and lab parameters.
- Logistic regression and nomogram analyses for diagnostic performance and risk factor identification.
Main Results:
- Of 2,015 children tested, 724 (35.9%) had pertussis; 187 (30.2%) were hospitalized, 55 (8.9%) admitted to ICU.
- Cases peaked May 2024, primarily in 3-11 year olds; pertussis cases showed higher WBC and procalcitonin (PCT) levels.
- PCT improved WHO case definition ROC area (0.710 to 0.870); cyanosis, post-tussive vomiting, neutrophils, and ventilation predicted ICU admission.
Conclusions:
- Pediatric pertussis epidemiology has shifted towards older children.
- Clinical features alone are insufficient for diagnosis; PCT enhances suspected-case definitions.
- Elevated neutrophil count is an independent predictor of ICU admission, useful for early risk stratification.
Objective:
This study aimed to characterize the epidemiology of pertussis in children, evaluate the diagnostic performance of clinical and laboratory features, assess the effectiveness of different suspected-case criteria, and identify independent risk factors for ICU admission.
Methods:
We retrospectively analyzed demographic, clinical, and laboratory data from patients aged ≤14 years who underwent pertussis testing. Participants were stratified by test results, and the sensitivity and specificity of individual symptoms and laboratory parameters were calculated. Diagnostic performance was further assessed using univariate and multivariate logistic regression and nomogram analyses.
Results:
Among 2,015 children tested, 724 (35.9%) were positive for pertussis, with 187 (30.2%) hospitalized and 55 (8.9%) admitted to the ICU. Cases increased from August 2023, peaking in May 2024, with the majority aged 3-11 years (51.8%). Compared with B. pertussis-negative children, positive cases exhibited higher WBC counts and procalcitonin (PCT) levels. Incorporating PCT into the WHO suspected-case definition improved the ROC area from 0.710 to 0.870, with an optimal cutoff of 0.1665 ng/mL. Cyanosis, post-tussive vomiting, neutrophil count, and assisted ventilation emerged as independent predictors of ICU admission, with a neutrophil cutoff of 6.62 × 109/L.
Conclusion:
The age distribution of pediatric pertussis shifted from young infants to preschool- and school-aged children. Clinical features alone are insufficient for reliable diagnosis due to overlap with non-pertussis cases. Elevated neutrophil count serves as an independent predictor of ICU admission, highlighting its potential utility for early risk stratification in pediatric pertussis.
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