Doctors often miss whooping cough diagnosis in teens

Doctors can do a better job of diagnosing whooping cough among teens, an age group with a growing incidence of the illness, according to a University of Michigan study.

In a national study of primary care physicians, U-M researchers found that nearly 1 out of 7 physicians were not able to recognize whooping cough in a standardized adolescent case patient. The study will appear in an upcoming edition of Preventive Medicine.

A similar proportion did not test adolescents for whooping cough as part of their routine clinical practice, says Amanda Dempsey, M.D., Ph.D., MPH, assistant professor of pediatrics and communicable diseases at the University of Michigan Medical School and the study's lead author.

Whooping cough is a common infection that leads to significant morbidity and sometimes death. Because adolescents are considered to be a primary infection-spreading group, researchers say it is imperative to recognize and diagnose it in a timely and accurate manner.

The study showed there is a need to increase provider education about the importance of recognizing whooping cough in order to minimize outbreaks.

Researchers selected family physicians and pediatricians as interview subjects because they are the specialists to interact the most with adolescent patients.

Researchers aimed to shed light on physician diagnostic, testing and case management approaches, hoping to help improve educational outreach programs to be used as improved diagnostic tests become available.

Results of the national survey of 702 general pediatricians and family medicine physicians - the first to explore physician practices for adolescent whooping cough management in the United States - suggest that testing, recognition of clinical symptoms, and case management of whooping cough in adolescents among primary care physicians is sub-optimal.

A majority of physicians surveyed, 86 percent, said they experienced at least one barrier to testing. These barriers included the delay in obtaining test results, having to send the patient to an outside facility to collect a sample, inaccurate diagnostic tests, and lack of testing supply availability.

Furthermore, a substantial proportion of physicians surveyed identified lack of familiarity with testing protocols as a major barrier to testing. Many said they did not recognize the clinical symptoms of whooping cough in a case patient. The study showed that doctors more familiar with the disease were more likely to manage the case patient appropriately.

In addition, nearly 10 percent of respondents in the study believed that clinical judgment was sufficient for diagnosing whooping cough.

"Clearly, the importance of clinical acumen in combination with a high index of suspicion cannot be overstated," Dempsey writes in the study. "But whopping cough often resembles other respiratory diseases early in the course of illness."

The study also highlighted important specialty-based differences in testing practices. It found that family practitioners were less likely than pediatricians to diagnose an adolescent with the illness in the past, test adolescents in their current practice, manage the case patient appropriately, and report cases to the health department. These results are consistent with other studies showing specialty-based differences in diagnostic and testing practices.

These differences appear to be influenced, at least in part, by the two groups' lack of familiarity with testing protocols and differences in the use of whooping cough prevention methods. As a result, future interventions aimed at improving doctors' knowledge about whooping cough diagnosis, treatment, containment and prevention options should be tailored to reflect the specific needs of each medical community.

Overall results of this study suggest that more efforts are needed to improve doctors' knowledge about the symptoms of and diagnostic procedures for identifying whooping cough.

More information: UMHS Whooping cough guide