A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children

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Abstract

Background

The differential diagnosis of paediatric respiratory conditions is difficult and suboptimal. Existing diagnostic algorithms are associated with significant error rates, resulting in misdiagnoses, inappropriate use of antibiotics and unacceptable morbidity and mortality. Recent advances in acoustic engineering and artificial intelligence have shown promise in the identification of respiratory conditions based on sound analysis, reducing dependence on diagnostic support services and clinical expertise. We present the results of a diagnostic accuracy study for paediatric respiratory disease using an automated cough-sound analyser.

Methods

We recorded cough sounds in typical clinical environments and the first five coughs were used in analyses. Analyses were performed using cough data and up to five-symptom input derived from patient/parent-reported history. Comparison was made between the automated cough analyser diagnoses and consensus clinical diagnoses reached by a panel of paediatricians after review of hospital charts and all available investigations.

Results

A total of 585 subjects aged 29 days to 12 years were included for analysis. The Positive Percent and Negative Percent Agreement values between the automated analyser and the clinical reference were as follows: asthma (97, 91%); pneumonia (87, 85%); lower respiratory tract disease (83, 82%); croup (85, 82%); bronchiolitis (84, 81%). Conclusion: The results indicate that this technology has a role as a high-level diagnostic aid in the assessment of common childhood respiratory disorders.

Trial registration

Australian and New Zealand Clinical Trial Registry (retrospective) - ACTRN12618001521213: 11.09.2018.

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Most cited references 39

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Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis.

Li Liu, Shefali Oza, Daniel B. Hogan … (2015)

Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.

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Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.

Shawn Ralston, Allan Lieberthal, H Meissner … (2014)

This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

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Diagnosis and management of bronchiolitis.

(2006)

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations. This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics. This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis.

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Author and article information

Contributors

Paul Porter:

ORCID: http://orcid.org/0000-0001-9051-589X

paul.porter@curtin.edu.au

Udantha Abeyratne: udantha@itee.uq.edu.au

Vinayak Swarnkar: vinayak@itee.uq.edu.au

Jamie Tan: Jamie.tan@outlook.com

Ti-wan Ng: ti@fernbay.management

Joanna M. Brisbane:

ORCID: http://orcid.org/0000-0003-3364-5414

joanna.brisbane@postgrad.curtin.edu.au

Deirdre Speldewinde: Deirdre.Speldewinde@health.wa.gov.au

Jennifer Choveaux: ChoveauxJ@ramsayhealth.com.au

Roneel Sharan: r.sharan@uq.edu.au

Keegan Kosasih: k.kosasih@uq.edu.au

Phillip Della: P.Della@curtin.edu.au

Journal

Journal ID (nlm-ta): Respir Res

Journal ID (iso-abbrev): Respir. Res

Title: Respiratory Research

Publisher: BioMed Central (London )

ISSN (Print): 1465-9921

ISSN (Electronic): 1465-993X

Publication date (Electronic): 6 June 2019

Publication date PMC-release: 6 June 2019

Publication date (Print): 2019

Volume: 20

Electronic Location Identifier: 81

Affiliations

[1 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, Curtin University, School of Nursing, Midwifery and Paramedicine, ; Kent Street, Bentley, Western Australia 6102 Australia

[2 ]Department of Paediatrics, Joondalup Health Campus, Suite 204, Cnr Grand Blvd and Shenton Ave, Joondalup, Western Australia 6027 Australia

[3 ]ISNI 0000 0004 0625 8600, GRID grid.410667.2, Department of Emergency Medicine, , Perth Children’s Hospital, ; 15 Hospital Ave, Nedlands, Western Australia 6009 Australia

[4 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, The University of Queensland, School of Information Technology and Electrical Engineering, ; Sir Fred Schonell Drive, St Lucia, Brisbane, QLD Australia

[5 ]Joondalup Health Campus, Cnr Grand Blvd and Shenton Ave, Joondalup, Western Australia 6027 Australia

Author information

Paul Porter http://orcid.org/0000-0001-9051-589X

Joanna M. Brisbane http://orcid.org/0000-0003-3364-5414

Article

Publisher ID: 1046

DOI: 10.1186/s12931-019-1046-6

PMC ID: 6551890

PubMed ID: 31167662

SO-VID: e5b744c9-8cca-4165-8df0-b4620f00f13f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 October 2018

Date accepted : 8 April 2019

Custom metadata

ScienceOpen disciplines: Respiratory medicine

Keywords: cough,childhood,respiratory,diagnosis,algorithm,croup,pneumonia,asthma,bronchiolitis

Data availability:

ScienceOpen disciplines: Respiratory medicine

Keywords: cough, childhood, respiratory, diagnosis, algorithm, croup, pneumonia, asthma, bronchiolitis

A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children

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Abstract

Background

Methods

Results

Trial registration

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European Respiratory Society: COVID-19

Most cited references 39

Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis.

Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.

Diagnosis and management of bronchiolitis.

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