title: A cough algorithm for chronic cough in children: a multicenter, randomized controlled study.
abstract: OBJECTIVE
  The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children.
  
  
  METHODS
  A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm ("early-arm"); or (2) usual care until review and use of cough algorithm ("delayed-arm"). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm's reliability, validity, and feasibility.
  
  
  RESULTS
  Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13-35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29-1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm's validity (93%-100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care.
  
  
  CONCLUSIONS
  Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. annechang@ausdoctors.net
authors.forename: Anne Bernadette
authors.initials: AB
authors.lastname: Chang
authors.forename: Colin Francis
authors.initials: CF
authors.lastname: Robertson
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: van Asperen
authors.forename: Nicholas John
authors.initials: NJ
authors.lastname: Glasgow
authors.forename: Ian Brent
authors.initials: IB
authors.lastname: Masters
authors.forename: Laurel
authors.initials: L
authors.lastname: Teoh
authors.forename: Craig Michael
authors.initials: CM
authors.lastname: Mellis
authors.forename: Louis Isaac
authors.initials: LI
authors.lastname: Landau
authors.forename: Julie Maree
authors.initials: JM
authors.lastname: Marchant
authors.forename: Peter Stanley
authors.initials: PS
authors.lastname: Morris
mesh_terms: D000465:Algorithms; D001315:Australia; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003371:Cough / Q000175:diagnosis* / Q000628:therapy*; D019091:Critical Pathways; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: children; cough; guidelines; randomized controlled trial