TY - JOUR
T1 - Signs and symptoms that rule out community-acquired pneumonia in outpatient adults
T2 - A systematic review and meta-analysis
AU - Marchello, Christian S.
AU - Ebell, Mark H.
AU - Dale, Ariella P.
AU - Harvill, Eric T.
AU - Shen, Ye
AU - Whalen, Christopher C.
N1 - Publisher Copyright:
© J Am Board Fam Med: first published as 10.3122/jabfm.2019.02.180219 on 8 March 2019. Downloaded from http://www.jabfm.org/ on 17 April 2019 by guest. Protected by copyright.
PY - 2019
Y1 - 2019
N2 - Background: A systematic review of clinical decision rules to identify patients at low risk for communityacquired pneumonia (CAP) has not been previously presented in the literature. Methods: A systematic review of MEDLINE for prospective studies that used at least 2 signs, symptoms, or point-of-care tests to determine the likelihood of CAP. We included studies that enrolled adults and adolescents in the outpatient setting where all or a random sample of patients received a chest radiograph as the reference standard. We excluded retrospective studies and studies that recruited primarily patients with hospital-acquired CAP. Results: Our search identified 974 articles, 12 of which were included in the final analysis. The simple heuristic of normal vital signs (temperature, respiratory rate, and heart rate) to identify patients at low risk for CAP was reported by 4 studies and had a summary estimate of the negative likelihood ratio (LR-) of 0.24 (95% CI, 0.17 to 0.34) and a sensitivity of 0.89 (95% CI, 0.79 to 0.94). The simple heuristic of normal vital signs combined with a normal pulmonary examination to identify patients at low risk for CAP was reported by 3 studies, and had a summary estimate of LR- of 0.10 (95% CI, 0.07 to 0.13) with an area under the receiver operating characteristic curve of 0.92. Conclusions: Adults with an acute respiratory infection who have normal vital signs and a normal pulmonary examination are very unlikely to have CAP. Given a baseline CAP risk of 4%, these patients have only a 0.4% likelihood of CAP. (J Am Board Fam Med 2019;32:234 -247.).
AB - Background: A systematic review of clinical decision rules to identify patients at low risk for communityacquired pneumonia (CAP) has not been previously presented in the literature. Methods: A systematic review of MEDLINE for prospective studies that used at least 2 signs, symptoms, or point-of-care tests to determine the likelihood of CAP. We included studies that enrolled adults and adolescents in the outpatient setting where all or a random sample of patients received a chest radiograph as the reference standard. We excluded retrospective studies and studies that recruited primarily patients with hospital-acquired CAP. Results: Our search identified 974 articles, 12 of which were included in the final analysis. The simple heuristic of normal vital signs (temperature, respiratory rate, and heart rate) to identify patients at low risk for CAP was reported by 4 studies and had a summary estimate of the negative likelihood ratio (LR-) of 0.24 (95% CI, 0.17 to 0.34) and a sensitivity of 0.89 (95% CI, 0.79 to 0.94). The simple heuristic of normal vital signs combined with a normal pulmonary examination to identify patients at low risk for CAP was reported by 3 studies, and had a summary estimate of LR- of 0.10 (95% CI, 0.07 to 0.13) with an area under the receiver operating characteristic curve of 0.92. Conclusions: Adults with an acute respiratory infection who have normal vital signs and a normal pulmonary examination are very unlikely to have CAP. Given a baseline CAP risk of 4%, these patients have only a 0.4% likelihood of CAP. (J Am Board Fam Med 2019;32:234 -247.).
KW - Community-acquired infections
KW - Meta-analysis
KW - Outpatients
KW - Pneumonia
KW - Prospective studies
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85058158301&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058158301&partnerID=8YFLogxK
U2 - 10.3122/jabfm.2019.02.180219
DO - 10.3122/jabfm.2019.02.180219
M3 - Review article
C2 - 30850460
AN - SCOPUS:85058158301
SN - 1557-2625
VL - 32
SP - 234
EP - 247
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 2
ER -