The Wisconsin Upper Respiratory Symptom Survey (WURSS) is an evaluative illness-specific quality of life instrument, designed to assess the negative impact of the common cold. Long (WURSS-44) and short (WURSS-21) versions are now available. A Spanish language adaptation has been created but has not yet been validated. If interested, please contact Dr. Barrett directly.

Acute upper respiratory infection (URI), also known as the common cold, is the most prevalent human illness. Surveys report that over 70% of people experience at least one cold in a given year, with adults averaging 2 or 3 colds and young children averaging as many as 4 to 6 colds per year. More than 45 million days of work and 22 million days of school are lost as a result. In the U.S. alone, more than $2 billion is spent out of pocket annually on cold remedies, with more than $7 billion in sick pay losses attributable to URI. A recent study estimated annual direct costs at $17 billion and indirect costs at $22.5 billion, for a total economic impact of close to $40 billion. URI is the most important cause of asthma exacerbation, and often leads to otitis media, sinusitis, bronchitis or pneumonia. For those at increased risk, such as the very old, those with multiple illnesses, or the immune compromised, URI may be fatal.

Despite the fact that more than 200 randomized controlled trials have spent millions of dollars testing dozens of cold remedies, prior to WURSS there was no well-developed, standardized and validated measure for assessing the symptomatic and functional impact of URI.

In order to develop and validate such an instrument, we chose to combine qualitative and quantitative methodologies. A published description of the development process is available:

B. Barrett, K. Locken, R. Maberry, J. Schwamman, J. Bobula, R. Brown, and E. Stauffacher. The Wisconsin Upper Respiratory Symptom Survey: Development of an instrument to measure the common cold. Journal of Family Practice 51(3):265-www.jfponline.com, 2002

We then went on to prospectively validate the WURSS-44, aiming for assessment of reliability, responsiveness, importance-to-patients, and convergent validity. Over 18 months some 149 people with colds filled out the WURSS-44, the Jackson scale and the SF-8 (24-hour recall version) each day from the beginning of their colds until their symptoms had resolved, generating a data set of 1,681 person-days. Using importance-to-patient and responsiveness as guides, a subset of items was selected for the WURSS-21, which is now undergoing prospective validation.

Factor analyses assessed association of items within illness domains, and generated reliability coefficients ranging from 0.72 to 0.94. Comparison of daily WURSS-44 scores with Jackson and SF-8 scores yielded correlation coefficients ranging from 0.60 to 0.93. Minimal important difference (MID) in terms of day-to-day change was calculated as 16.7 points for the WURSS-44, 9.5 for the WURSS-21, 1.6 for the Jackson scale, and 4.5 for the SF-8. Dividing these MIDs by the square root of twice their mean square error yielded the following Guyatt responsiveness indices: 0.71 for the WURSS-44, 0.80 for the WURSS-21, 0.61 for Jackson and 0.54 for the SF-8. These imply that a two-armed trial using these instruments would require the following number of participants in order to have a 80% chance of detecting these levels of day-to-day change (assuming alpha = 0.05 and two-tailed testing): 92 for the WURSS-44, 74 for the WURSS-21, 124 for Jackson, and 156 for the SF-8. Because we selected WURSS-21 items based on responsiveness as well as importance-to-patient, we suspect that the WURSS-21 will not prove quite as responsive in prospective validation as it did as items embedded within the WURSS-44. Details on the validation process and results are available at:

B. Barrett, R. L. Brown, M. P. Mundt, N. Safdar, L. Dye, R. Maberry, and J. Alt. The Wisconsin Upper Respiratory Symptom Survey is responsive, reliable, and valid. Journal of Clinical Epidemiology. 58 (6):609-617, 2005.

A third paper comparing WURSS with laboratory-based measures has also been published. Using data from a randomized controlled trial in an induced cold experimental rhinovirus infection model, this paper compares WURSS scores with quantitative viral culture, nasal mucus weight, neutrophil count, interleukin-8 and glutathione, and with the self-report questionnaire scores from tha Jackson cold scale and the SF-8 general health-related quality-of-life instrument.

B. Barrett, R. Brown, R. Voland, R. Maberry, and R. Turner. Relations among questionnaire and laboratory measures of rhinovirus infection. European Respiratory Journal 28 (2):358-363, 2006.

A fourth manuscript detailing anchor-based and distribution-based methods of assessing important difference and responsiveness has been published very recently:

B. Barrett, R. Brown, and M. Mundt. Comparison of anchor-based and distributional approaches in estimating important difference in common cold. Qual.Life Res. 17 (1):75-85, 2008.

Ongoing work prospectively validating the WURSS-21 against the WURSS-44 and several other measures is nearing completion. Data analysis and manuscript preparation are forthcoming.