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Meta-Analysis
. 2019 May 20;9(1):7600.
doi: 10.1038/s41598-019-44145-y.

Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review

Tha Pyai Htun  1   2 , Yinxiaohe Sun  1   2 , Hui Lan Chua  1   2 , Junxiong Pang  3   4
Affiliations
Meta-Analysis

Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review

Tha Pyai Htun et al. Sci Rep. .

Abstract

Pneumonia results in significant morbidity and mortality worldwide. However, chest radiography may not be accessible in primary care setting. We aimed to evaluate clinical features and its diagnostic value to identify pneumonia among adults in primary care settings. Three academic databases were searched and included studies that assessed clinical predictors of pneumonia, adults without serious illness, have CXR and have conducted in primary care settings. We calculated sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio of each index test and the pool estimates for index tests. We identified 2,397 articles, of which 13 articles were included. In our meta-analysis, clinical features with the best pooled positive likelihood ratios were respiratory rate ≥20 min-1 (3.47; 1.46-7.23), temperature ≥38 °C (3.21; 2.36-4.23), pulse rate >100 min-1 (2.79; 1.71-4.33), and crackles (2.42; 1.19-4.69). Laboratory testing showed highest pooled positive likelihood ratios with PCT >0.25 ng/ml (7.61; 3.28-15.1) and CRP > 20 mg/l (3.76; 2.3-5.91). Cough, pyrexia, tachycardia, tachypnea, and crackles are limited as a single predictor for diagnosis of radiographic pneumonia among adults. Development of clinical decision rule that combine these clinical features together with molecular biomarkers may further increase overall accuracy for diagnosis of radiographic pneumonia among adults in primary care setting.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study selection.
Figure 2
Figure 2
Graphical illustration of risk of bias and applicability concerns.
Figure 3
Figure 3
Summary of risk of bias and applicability concerns.
Figure 4
Figure 4
Summary ROC plot for socio-demographic, symptoms, signs and laboratory tests.
See this image and copyright information in PMC

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