Does This Patient Have Pertussis? Bedside Clues to Diagnosis

Written by Clay Smith

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Adults with cough <3weeks or 3-8 weeks with post-tussive vomiting or whooping should be treated for pertussis; those with fever or without paroxysmal cough should be considered to have an alternate diagnosis.  Children with <4 weeks of cough and post-tussive vomiting may have pertussis, but it was much less clear than in adults.

Why does this matter?
Most of the time cough or bronchitis is viral.  Sometimes it is something much more, such as pertussis.  How can we tell the difference at the bedside?  This guideline is a restatement of a prior systematic review and meta-analysis in 2017.

Not just a cold
This was a systematic review designed to answer this question: “In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough?”

For adults with <3 weeks of cough or 3-8 weeks of cough:

  • Post-tussive vomiting or whooping should be considered as ruling in pertussis.  Specificity was 80% and 78%, respectively.  Sensitivity was low, 30% and 33%, respectively.

  • Lack of paroxysmal cough or presence of fever rule it out. Sensitivity was 93% and 82%, respectively.  Specificity was low, 21% and 19%, respectively.

For children with <4 weeks of cough, post-tussive vomiting may suggest pertussis but was not as helpful in making a bedside diagnosis.  Sensitivity was only 60%; specificity just 66%.

Source
Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: Chest Guideline and Expert Panel Report.  Chest. 2018 Oct 12. pii: S0012-3692(18)32575-3. doi: 10.1016/j.chest.2018.09.027. [Epub ahead of print]

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