Some physicians struggle with diagnosing pertussis in adolescents

One out of seven physicians were not able to accurately diagnose pertussis and too few physicians are testing adolescent patients for this illness, according to a survey conducted by University of Michigan researchers.

Amanda Dempsey, MD, PhD, MPH, assistant professor of pediatrics and communicable diseases at the University of Michigan Medical School, said their findings demonstrate a need to increase provider education in recognizing pertussis to ensure fewer outbreaks.

The survey of 702 general pediatricians and family medicine physicians revealed testing, recognition of clinical symptoms and case management of pertussis in teens is insufficient, with 86% of physicians saying they experienced at least one barrier to pertussis testing.

Physicians said they struggle with delays in obtaining test results (52%), inaccurate sample collection (29%), a shortage of testing supplies (29%) and a lack of familiarity with testing protocols (28%). Cost was also cited a barrier.

Ten percent of the physicians in the survey believed that their clinical judgment alone was enough to diagnose a case of pertussis.

“Clearly, the importance of clinical acumen in combination with a high index of suspicion cannot be overstated,” Dempsey and colleagues noted in the study. “But whooping cough often resembles other respiratory diseases early in the course of illness.”

The study also highlighted important specialty-based differences in testing practices. The researchers noted that family practitioners were less likely than pediatricians to diagnose an adolescent with the illness in the past, test adolescents in their current practice and report cases to the health department.

Consequently, “efforts must be made to improve doctors’ knowledge about diagnosing, treating, and preventing pertussis, especially to reflect the specific needs of all medical communities,” Dempsey and colleagues wrote.

Preventive Medicine. 48(5); 2009, 500-504.