1. Management of pediatric chronic cough using an algorithm significantly decreased cough duration and increased the probability of cough resolution.
2. The cough algorithm was reliable (k=1), valid (93-100%), and effective (99.6%).
Evidence Rating Level: 1 (Excellent)
Study Rundown: Using a randomized controlled study design, this study compares the use of a management algorithm to standard of care outpatient management and specialist referral. Duration of cough was less and cough resolution more likely in the group randomized to the algorithm. Importantly, these clinical improvement outcomes were both qualitative and quantitative. The algorithm was additionally found to be provider-independent, with a 99.6% overall efficacy rate. Interestingly, most children (85%) had diagnoses that could be managed by primary care, while only 15% required specialist management. Each patient was evaluated by specialists who were not blinded to the study design, suggesting that the chronic cough algorithm needs to be further evaluated in an exclusively primary care population to establish the reliability of the key signs and symptoms used in the algorithm.
Relevant Reading: Clinical pathways for chronic cough in children
In-Depth [randomized controlled trial]: This study evaluated the efficacy of an outpatient algorithm for chronic cough management in pediatric patients. A total of 226 children < 18 years of age with chronic cough (> 4 weeks) were randomized to either early (< 3 weeks) or delayed (within 6-8 weeks) use of a chronic cough algorithm that involved evaluation by a specialist. The study endpoint was defined as establishment of a primary diagnosis, hospitalization, or resolution of cough for >3 consecutive days within the 12-month study period. The proportion of cough-free children at week 6 was higher in the early arm (54.3% vs 29.5% delayed, p < 0.0001), as were quality of life scores. Importantly, the cough algorithm yielded a diagnosis in 99.6% of children and was reliable (k=1), with a clinical failure rate of 0.4% and a validity of 93-100%.
By Emilia Hermann and Devika Bhushan
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