Sensibilidade, especificidade e pontos de corte do Índice de Severidade da Tosse (CSI-Br) e do Questionário Newcastle de Hipersensibilidade Laríngea (LHQ-Br) em indivíduos com tosse crônica refratária
Sensitivity, specificity, and cutoff points of the Cough Severity Index (CSI-Br) and the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in individuals with chronic refractory cough
Camila Moura Menezes; Rodrigo Dornelas; Mara Behlau; Vanessa Veis Ribeiro
Resumo
Objetivo: Estabelecer pontos de corte e avaliar a acurácia discriminativa dos instrumentos de autopercepção Índice de Severidade da Tosse (CSI-Br) e Questionário Newcastle de Hipersensibilidade Laríngea (LHQ-Br) na identificação de sintomas relacionados à tosse crônica refratária (TCR) em indivíduos adultos. Método: Trata-se de um estudo transversal, observacional e quantitativo. A amostra foi composta por 157 participantes, com idade média de 44,92 anos, sendo 111 do sexo feminino e 46 do sexo masculino. Os participantes foram distribuídos em dois grupos a partir da presença ou não de TCR: Grupo com TCR (GT) com 110 participantes, sendo 31 do sexo masculino e 79 do sexo feminino, idade média de 48,67 (DP: 16,04) anos; e, Grupo Controle Saudável (GC) com 47 participantes, sendo 15 do sexo masculino e 32 do feminino, idade média de 36,34 (DP: 14,31) anos. A coleta de dados foi presencial nos ambulatórios dos hospitais participantes e on-line via Google Forms. Os participantes responderam o CSI-Br e o LHQ-Br. A análise foi realizada no software SPSS 29.0, utilizando curvas ROC para determinar pontos de corte e métricas de desempenho. Resultados: Para o LHQ-Br, a área sob a curva (AUC) foi de 0,753, com ponto de corte de 5,8, sensibilidade de 70% e especificidade de 73,4%. O CSI-Br apresentou AUC de 0,894 no escore total, com ponto de corte de 4,5, sensibilidade de 84,9% e especificidade de 83%. Conclusão: Conclui-se que a partir dos pontos de corte estabelecidos, ambos se mostraram sensíveis e específicos, com maior robustez para o CSI-Br.
Palavras-chave
Abstract
Purpose: To establish cutoff points and evaluate the discriminative accuracy of the self-perception instruments Cough Severity Index (CSI-Br) and Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in identifying symptoms related to chronic refractory cough (CRC) in adults. Methods: This is a cross-sectional, observational, quantitative study with a sample of 157 participants (111 females and 46 males), with a mean age of 44.92 years. They were divided into two groups based on the presence or absence of CRC: Group with CRC (CRC-G) with 110 participants (31 males and 79 females), with a mean age of 48.67 (SD: 16.04) years; The study included a healthy control group (CG) with 47 participants (15 males and 32 females), with a mean age of 36.34 (SD: 14.31) years. Data were collected in person at the outpatient clinics of the participating hospitals and online via Google Forms. Participants answered the CSI-Br and LHQ-Br. Analysis was performed using SPSS 29.0 software, employing ROC curves to determine cutoffs and performance metrics. Results: For the LHQ-Br, the area under the curve (AUC) was 0.753, with a cutoff of 5.8, sensitivity of 70%, and specificity of 73.4%. The CSI-Br had an AUC of 0.894 in the total score, with a cutoff of 4.5, sensitivity of 84.9%, and specificity of 83%. Conclusion: Based on the established cutoffs, both questionnaires proved to be sensitive and specific, with greater robustness for CSI-Br.
Keywords
Referências
- 1Vertigan AE, Theodoros DG, Gibson PG, Winkworth AL. The relationship between chronic cough and paradoxical vocal fold movement: a review of the literature. J Voice. 2006;20(3):466-80. https://doi.org/10.1016/j.jvoice.2005.08.001 PMid:16274959.
» https://doi.org/10.1016/j.jvoice.2005.08.001 - 2SBPT: Sociedade Brasileira de Pneumologia e Tisiologia. II Diretrizes brasileiras no manejo da tosse crônica. J Bras Pneumol. 2006;32(Suppl 4):S403-46. https://doi.org/10.1590/S1806-37132006001000002
» https://doi.org/10.1590/S1806-37132006001000002 - 3Vertigan AE, Gibson PG. Chronic refractory cough as a sensory neuropathy: evidence from a reinterpretation of cough triggers. J Voice. 2011;25(5):596-601. https://doi.org/10.1016/j.jvoice.2010.07.009 PMid:21051202.
» https://doi.org/10.1016/j.jvoice.2010.07.009 - 4Poulose V, Bin Mohd I. Prolonged cough presenting with diagnostic difficulty: a study of aetiological and clinical outcomes. Singapore Med J. 2011;52(4):267-70. PMid:21552788.
- 5Ando A, Smallwood D, McMahon M, Irving L, Mazzone SB, Farrell MJ. Neural correlates of cough hypersensitivity in humans: evidence for central sensitisation and dysfunctional inhibitory control. Thorax. 2016;71(4):323-9. https://doi.org/10.1136/thoraxjnl-2015-207425 PMid:26860344.
» https://doi.org/10.1136/thoraxjnl-2015-207425 - 6Gibson PG, Vertigan AE. Speech pathology for chronic cough: a new approach. Pulm Pharmacol Ther. 2009;22(2):159-62. https://doi.org/10.1016/j.pupt.2008.11.005 PMid:19061964.
» https://doi.org/10.1016/j.pupt.2008.11.005 - 7Dornelas R, Ribeiro VV, Behlau M. Tosse crônica e fonoaudiologia. CoDAS. 2021;34(1):e20210127. https://doi.org/10.1590/2317-1782/20212021127 PMid:34730666.
» https://doi.org/10.1590/2317-1782/20212021127 - 8Lilly GL, Carroll T, Pietsch K, Dhillon V, Bryson PC, Akst LM. Refractory chronic cough: a state-of-the-art review for otolaryngologists. Otolaryngol Head Neck Surg. 2025;172(2):419-35. https://doi.org/10.1002/ohn.1019 PMid:39575647.
» https://doi.org/10.1002/ohn.1019 - 9Vertigan A, Gibson P. The role of speech pathology in the management of patients with chronic refractory cough. Lung. 2012;190(1):35-40. https://doi.org/10.1007/s00408-011-9333-0 PMid:21989493.
» https://doi.org/10.1007/s00408-011-9333-0 - 10Dornelas R, Casmerides MCB, Silva RC, Souza MVA, Pereira LT, Ribeiro VV, et al. Clinical parameters of the speech-language pathology assessment of the chronic cough: a scoping review. J Voice. 2024;38(3):703-10. https://doi.org/10.1016/j.jvoice.2021.12.012 PMid:35012819.
» https://doi.org/10.1016/j.jvoice.2021.12.012 - 11Spinou A, Birring SS. An update on measurement and monitoring of cough: what are the important study endpoints? J Thorac Dis. 2014;6(Suppl 7):S728-34. https://doi.org/10.3978/j.issn.2072-1439.2014.10.08 PMid:25383207.
» https://doi.org/10.3978/j.issn.2072-1439.2014.10.08 - 12Ribeiro VV, Lopes LW, Silva ACF, Medeiros AH No, Gartner-Schmidt J, Behlau M. Cough severity index in Brazilian Portuguese: translation and cross-cultural adaptation. J Voice. 2022;36(2):289.e11. https://doi.org/10.1016/j.jvoice.2020.05.010 PMid:32576524.
» https://doi.org/10.1016/j.jvoice.2020.05.010 - 13Ribeiro VV, Lopes LW, da Silva ACF, Medeiros AH No, Gartner-Schmidt J, Behlau M. Cough Severity Index: validation in Brazilian Portuguese. J Voice. 2023;37(6):967.e15-20. https://doi.org/10.1016/j.jvoice.2021.06.014 PMid:34266734.
» https://doi.org/10.1016/j.jvoice.2021.06.014 - 14Ribeiro VV, Vertigan A, Behlau M. Translation and cross-cultural adaptation of the newcastle laryngeal hypersensitivity questionnaire to Brazilian Portuguese. J Voice. 2020;34(6):964.e23-34. https://doi.org/10.1016/j.jvoice.2019.06.007 PMid:31307901.
» https://doi.org/10.1016/j.jvoice.2019.06.007 - 15Ribeiro VV, Lopes LW, Silva ACF, Medeiros AH No, Vertigan A, Behlau M. Validation of Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in Brazilian Portuguese. J Voice. 2023;37(6):967.e9-13. https://doi.org/10.1016/j.jvoice.2021.06.012 PMid:34272140.
» https://doi.org/10.1016/j.jvoice.2021.06.012 - 16Shembel AC, Rosen CA, Zullo TG, Gartner-Schmidt JL. Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway. Laryngoscope. 2013;123(8):1931-6. https://doi.org/10.1002/lary.23916 PMid:23737389.
» https://doi.org/10.1002/lary.23916 - 17Vertigan AE, Bone SL, Gibson PG. Development and validation of the Newcastle laryngeal hypersensitivity questionnaire. Cough. 2014;10(1):1. https://doi.org/10.1186/1745-9974-10-1 PMid:24552215.
» https://doi.org/10.1186/1745-9974-10-1 - 18Polo TCF, Miot HA. Use of ROC curves in clinical and experimental studies. J Vasc Bras. 2020;19:e20200186. https://doi.org/10.1590/1677-5449.200186 PMid:34211533.
» https://doi.org/10.1590/1677-5449.200186 - 19Hanley JA. Receiver operating characteristic (ROC) methodology: the state of the art. Crit Rev Diagn Imaging. 1989;29(3):307-35. PMid:2667567.
- 20Nahm FS. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol. 2022;75(1):25-36. https://doi.org/10.4097/kja.21209 PMid:35124947.
» https://doi.org/10.4097/kja.21209 - 21van Stralen KJ, Stel VS, Reitsma JB, Dekker FW, Zoccali C, Jager KJ. Diagnostic methods I: sensitivity, specificity and other measures of accuracy. Kidney Int. 2009;75(12):1257-63. https://doi.org/10.1038/ki.2009.92 PMid:19340091.
» https://doi.org/10.1038/ki.2009.92
Submetido em:
25/06/2025
Aceito em:
22/10/2025
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