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Typical RSV cough: myth or reality? A diagnostic accuracy study

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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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Abbreviations

MLPA:

Multiplex ligation-dependent probe amplification

PCR:

Polymerase chain reaction

RSV:

Respiratory syncytial virus

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Acknowledgements

We would like to thank all infants, parents and caregivers. Furthermore, we would like to express our appreciation to the nurses, residents and senior staff that enthusiastically completed the research questionnaire. Finally, our special thanks to Dr. Charles Stewart for editing the final draft of this article.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands

    Mirjam Binnekamp & Marlies A. van Houten

  2. Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands

    Mirjam Binnekamp, Karlijn J. van Stralen, Larissa den Boer & Marlies A. van Houten

Authors
  1. Mirjam Binnekamp
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  2. Karlijn J. van Stralen
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  3. Larissa den Boer
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  4. Marlies A. van Houten
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Contributions

MvH was initiator of this study. All the authors participated in designing the study. MB and MvH were responsible for the clinical implementation, data collection and development of the cough questionnaire. KvS performed all statistical analyses. MB composed the first draft of the article and LdB, KvS and MvH significantly contributed to revising this content. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Marlies A. van Houten.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the standards of the institutional research committee (Spaarne Gasthuis) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent from parents or caregivers of all participants included in the study was obtained.

Additional information

Communicated by Piet Leroy

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Binnekamp, M., van Stralen, K.J., den Boer, L. et al. Typical RSV cough: myth or reality? A diagnostic accuracy study. Eur J Pediatr 180, 57–62 (2021). https://doi.org/10.1007/s00431-020-03709-1

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  • DOI: https://doi.org/10.1007/s00431-020-03709-1

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