Diagnostic Accuracy of Clinical Decision Rules Using Signs, Symptoms, and Point of Care Tests to Diagnose (Rule In) Pneumonia
| Author, Year | CDR used to diagnose CAP (rule in) | CDR expressed as low yield criteria (rule out) | Sensitivity (TP/TP+FN) | Specificity (TN/TN+FP) | LR+ | LR− |
|---|---|---|---|---|---|---|
| Ebrahimzadeh, 2015 | Any abnormal VS | Normal VS | 0.86 (361/420) | 0.72 (302/420) | 3.06 | 0.20 |
| Any abnormal VS or PE finding | Normal VS and no PE findings | 0.94 (395/420) | 0.57 (241/420) | 2.21 | 0.10 | |
| Any abnormal lab (CRP, ESR, WBC) | Normal labs | 0.60 (254/420) | 0.74 (310/420) | 2.31 | 0.54 | |
| Gennis, 1989 | Any abnormal VS | Normal VS | 0.97 (114/118) | 0.19 (36/190) | 1.19 | 0.18 |
| Any abnormal auscultatory findings | Normal auscultatory findings | 0.78 (92/118) | 0.38 (73/190) | 1.27 | 0.57 | |
| Holm, 2007 | GP diagnosis of CAP and CRP ≥ 20 | GP diagnosis of CAP or CRP < 20 | 0.49 (23/47) | 0.84 (249/297) | 3.03 | 0.61 |
| GP diagnosis of CAP and SATO2 ≤ 95% | GP diagnosis of CAP or SATO2 > 95% | 0.32 (15/47) | 0.92 (268/291) | 4.04 | 0.74 | |
| GP diagnosis of CAP or CRP ≥ 20 | GP diagnosis of CAP and CRP < 20 | 0.83 (39/47) | 0.48 (144/297) | 1.61 | 0.35 | |
| GP diagnosis of CAP or SATO2 ≤ 95% | GP diagnosis of CAP and SATO2 > 95% | 0.79 (37/47) | 0.56 (164/291) | 1.80 | 0.38 | |
| Hopstaken, 2003 | >1 (diarrhea, dry cough, ≥ 38C) or CRP ≥ 20 | <=1 of 3 sign/symptom + CRP <20 | 0.91 (29/32) | 0.49 (104/211) | 1.79 | 0.19 |
| >1 (diarrhea, dry cough, ≥ 38C) or ESR ≥ 20 | <=1 of 3 sign/symptom + ESR <20 | 0.81 (26/32) | 0.55 (115/211) | 1.79 | 0.34 | |
| Melbye, 1992 | Abnormal auscultatory signs | Normal auscultatory signs | 0.40 (8/12) | 0.88 (336/382) | 3.32 | 0.68 |
| O'Brien, 2006 | Any abnormal VS | Normal VS | 0.81 (282/350) | 0.64 (225/350) | 2.26 | 0.30 |
| Any abnormal VS or PE finding | Normal VS and no PE findings | 0.95 (333/350) | 0.56 (196/350) | 2.16 | 0.09 | |
| Saldias, 2007 | Any abnormal VS | Normal VS | 0.86 (89/103) | 0.44 (85/193) | 1.54 | 0.31 |
| Abnormal VS or PE finding | Normal VS and no PE findings | 0.98 (101/103) | 0.19 (37/193) | 1.21 | 0.10 | |
| Singal, 1989 | Fever, cough, crackles | Absence of fever, cough, crackles | 0.93 (37/40) | 0.27 (57/215) | 1.26 | 0.28 |
| Steurer, 2011 | CRP>50 or CRP 11–50 and dyspnea or daily fever | CRP < 10 or CRP 11–50, no dyspnea, and no daily fever | 1.00 (127/127) | 0.38 (190/494) | 1.63 | 0.00 |
CDR: clinical decision rule; CAP; community-acquired pneumonia; VS: vital signs; PE: pulmonary exam; GP: general practitioner; CRP: c-reactive protein; ESR: erythrocyte sedimentation rate; WBC: white blood cell count; SATO2: oxygen saturation; Sensitivity and specificity calculated using ruling in criteria.