Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review
Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review
复制标题
DOI：
10.1038/s41598-019-44145-y
复制
发表时间：
2019-05-20
影响因子：
4.6
通讯作者：
Pang, Junxiong
中科院分区：
文献类型：
--
作者：
Htun, Tha Pyai;Sun, Yinxiaohe;Pang, Junxiong
在世界范围内，肺炎的发病率和死亡率都很高。然而，胸部x线摄影在初级保健机构可能无法获得。我们的目的是评估临床特征及其在初级保健机构中识别成人肺炎的诊断价值。我们检索了三个学术数据库，包括评估肺炎的临床预测因素、无严重疾病的成年人、有CXR和在初级保健机构进行的研究。计算各指标试验的敏感性、特异性、阳性和阴性似然比、诊断优势比以及指标试验的池估计。我们确定了2397篇文章，其中13篇被纳入。在我们的meta分析中，合并阳性似然比最佳的临床特征是呼吸率>= 20 min(-1)(3.47; 1.46-7.23)，体温>= 38℃（3.21;2.36-4.23），脉搏率>100 min(-1)（2.79; 1.71-4.33）和爆裂（2.42;1.19-4.69）。实验室检测显示PCT >0.25 ng/ml（7.61; 3.28-15.1）和CRP > 20 mg/l（3.76; 2.3-5.91）的合并阳性似然比最高。咳嗽、发热、心动过速、呼吸急促和噼啪声作为成人影像学诊断肺炎的单一预测指标是有限的。将这些临床特征与分子生物标志物相结合的临床决策规则的发展可能进一步提高初级保健机构成人放射学肺炎诊断的总体准确性。
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 degrees 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.