Clinical management decisions for adults with prolonged acute cough: Frequency and associated factors

Christian S. Marchello, Mark H. Ebell, Brian McKay, Ye Shen, Eric T. Harvill, Christopher C. Whalen

Research output: Contribution to journalArticle

Abstract

Background: Uncomplicated episodes of prolonged acute cough are usually viral and self-limited, but despite evidence and recommendations to the contrary, they are often treated with antibiotics. Methods: Mixed cross-sectional and prospective observational study of adults 18 years or older presenting to two urgent care centers with a cough of 7 to 56 days as their chief complaint. Factors associated with cough duration and clinical decisions were analyzed by univariate and multivariate logistic regression. Results: Of the 125 enrolled patients, 118 (94%) received an antibiotic, 97 (78%) a cough suppressant, 87 (70%) a systemic corticosteroid, and 39 (31%) a chest X-ray (CXR). Longer duration of cough was associated with the presence of self-reported wheezing or noises (adjusted odds ratio 6.29, 95% CI 1.36–29.16) while the presence of both wheezing and crackles on a clinician chest exam was associated with shorter duration (aOR 0.03, 95% CI 0.00–0.27). A clinician was more likely to order a CXR in patients with dyspnea (aOR 3.01, 95% CI 1.21–7.49), less likely to prescribe a systemic corticosteroid in patients with crackles (aOR 0.27, 95% CI 0.09–0.82), and more likely to prescribe a cough suppressant to older patients (1.04 per additional year of age, 95% CI 1.01–1.07). Conclusions: Systemic corticosteroids and cough suppressants are being prescribed at high rates in patients with uncomplicated acute cough in the urgent care setting. Additional studies to determine if similar rates are seen in other urgent care centers, or in other contemporary ambulatory settings are warranted.

Original languageEnglish (US)
Pages (from-to)1681-1685
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Cough
Respiratory Sounds
Antitussive Agents
Adrenal Cortex Hormones
Thorax
Ambulatory Care Facilities
X-Rays
Anti-Bacterial Agents
Ambulatory Care
Dyspnea
Observational Studies
Noise
Logistic Models
Odds Ratio
Prospective Studies

Keywords

  • Clinical management
  • Corticosteroids
  • Cough
  • Urgent care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Clinical management decisions for adults with prolonged acute cough : Frequency and associated factors. / Marchello, Christian S.; Ebell, Mark H.; McKay, Brian; Shen, Ye; Harvill, Eric T.; Whalen, Christopher C.

In: American Journal of Emergency Medicine, Vol. 37, No. 9, 01.09.2019, p. 1681-1685.

Research output: Contribution to journalArticle

Marchello, Christian S. ; Ebell, Mark H. ; McKay, Brian ; Shen, Ye ; Harvill, Eric T. ; Whalen, Christopher C. / Clinical management decisions for adults with prolonged acute cough : Frequency and associated factors. In: American Journal of Emergency Medicine. 2019 ; Vol. 37, No. 9. pp. 1681-1685.
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abstract = "Background: Uncomplicated episodes of prolonged acute cough are usually viral and self-limited, but despite evidence and recommendations to the contrary, they are often treated with antibiotics. Methods: Mixed cross-sectional and prospective observational study of adults 18 years or older presenting to two urgent care centers with a cough of 7 to 56 days as their chief complaint. Factors associated with cough duration and clinical decisions were analyzed by univariate and multivariate logistic regression. Results: Of the 125 enrolled patients, 118 (94{\%}) received an antibiotic, 97 (78{\%}) a cough suppressant, 87 (70{\%}) a systemic corticosteroid, and 39 (31{\%}) a chest X-ray (CXR). Longer duration of cough was associated with the presence of self-reported wheezing or noises (adjusted odds ratio 6.29, 95{\%} CI 1.36–29.16) while the presence of both wheezing and crackles on a clinician chest exam was associated with shorter duration (aOR 0.03, 95{\%} CI 0.00–0.27). A clinician was more likely to order a CXR in patients with dyspnea (aOR 3.01, 95{\%} CI 1.21–7.49), less likely to prescribe a systemic corticosteroid in patients with crackles (aOR 0.27, 95{\%} CI 0.09–0.82), and more likely to prescribe a cough suppressant to older patients (1.04 per additional year of age, 95{\%} CI 1.01–1.07). Conclusions: Systemic corticosteroids and cough suppressants are being prescribed at high rates in patients with uncomplicated acute cough in the urgent care setting. Additional studies to determine if similar rates are seen in other urgent care centers, or in other contemporary ambulatory settings are warranted.",
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