Teen Health
Doctors Often Miss Whooping Cough Diagnosis in Teens
By
May 19, 2009 - 9:54:26 AM

(HealthNewsDigest.com) - ANN ARBOR, Mich - 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:
http://health.med.umich.edu/healthcontent.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW%5FKnowledgebase&AEArticleID=hw65653&AEArticleType=HealthConditions

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