Clinical Decision Rules That Used a Point Score to Diagnose Pneumonia
Author, Year (Signs, Symptoms, Tests Used in CDR) | CDR Score | CAP | No CAP | PV | LR |
---|---|---|---|---|---|
Diehr, 19847 | −3 | 0 | 140 | 0.0% | 0.00 |
(>37.8°C, | −2 | 4 | 552 | 0.7% | 0.27 |
>25 breath/min, | −1 | 8 | 504 | 1.6% | 0.59 |
myalgia, night | 0 | 7 | 316 | 2.2% | 0.82 |
sweats, sputum, | 1 | 12 | 124 | 8.8% | 3.60 |
sore throat, | 2 | 6 | 52 | 10.3% | 4.29 |
rhinorrhea) | 3 | 4 | 12 | 25.0% | 12.41 |
4 | 3 | 8 | 27.3% | 13.96 | |
5 | 1 | 4 | 20.0% | 9.30 | |
6 | 1 | 0 | 100.0% | † | |
Total | 46 | 1712 | |||
Low: −3 to −2* | 4 | 1512 | 0.3% | 0.10 | |
Mod: −1 to 1* | 27 | 176 | 13.3% | 5.7 | |
High: 2 to 6* | 15 | 24 | 38.5% | 23.3 | |
Heckerling, 19906 | Derivation: Illinois | ||||
(>37.8°C, | 0 | 1 | 48 | 2.0% | 0.12 |
HR >100/min, | 1 | 11 | 316 | 3.4% | 0.20 |
rales, absence of | 2 | 28 | 232 | 10.8% | 0.70 |
asthma, decrease | 3 | 42 | 149 | 22.0% | 1.64 |
breath sounds) | 4 | 37 | 30 | 55.2% | 7.18 |
5 | 15 | 5 | 75.0% | 17.5 | |
Total | 134 | 780 | |||
Low: 0 to 1* | 12 | 364 | 3.2% | 0.19 | |
Mod: 2 to 3* | 70 | 381 | 15.5% | 1.07 | |
High: 4 to 5* | 52 | 35 | 59.8% | 8.6 | |
Validation: Nebraska | |||||
0 | 0 | 5 | 0.0% | 0.000 | |
1 | 3 | 28 | 9.7% | 0.20 | |
2 | 11 | 26 | 29.7% | 0.78 | |
3 | 12 | 16 | 42.9% | 1.38 | |
4 | 11 | 2 | 84.6% | 10.1 | |
5 | 5 | 0 | 100.0% | † | |
Total | 42 | 77 | |||
Low: 0 to 1* | 3 | 33 | 8.3% | 0.17 | |
Mod: 2 to 3* | 23 | 42 | 35.4% | 1.00 | |
High: 4 to 5* | 16 | 2 | 88.9% | 14.7 | |
Validation: Virginia | |||||
0 | 1 | 7 | 12.5% | 0.51 | |
1 | 2 | 30 | 6.3% | 0.24 | |
2 | 8 | 44 | 15.4% | 0.65 | |
3 | 6 | 16 | 27.3% | 1.35 | |
4 | 11 | 8 | 57.9% | 4.93 | |
5 | 1 | 0 | 100.0% | † | |
Total | 29 | 104 | |||
Low: 0 to 1* | 3 | 37 | 7.5% | 0.29 | |
Mod: 2 to 3* | 14 | 60 | 18.9% | 0.84 | |
High: 4 to 5* | 12 | 8 | 60.0% | 54 | |
Pooled | |||||
0 | 2 | 60 | 3.2% | 0.16 | |
1 | 16 | 374 | 4.1% | 0.20 | |
2 | 47 | 302 | 13.5% | 0.73 | |
3 | 60 | 181 | 24.9% | 1.55 | |
4 | 59 | 40 | 59.6% | 6.92 | |
5 | 21 | 5 | 80.8% | 19.7 | |
Total | 60 | 205 | |||
Low: 0 to 1* | 18 | 434 | 4.0% | 0.19 | |
Mod: 2 to 3* | 107 | 483 | 18.1% | 1.04 | |
High: 4 to 5* | 80 | 45 | 64.0% | 8.33 | |
van Vugt, 20139 (decreased breath sounds, crackles, breathlessness, vesicular breath sounds, absence of runny nose, >37.8C, HR >100/min, CRP >30) | CDR w/out CRP | ||||
Low: <2.5% | 11 | 654 | 1.7% | 0.32 | |
Mod: 2.5% to 20% | 105 | 1987 | 5.0% | 1.01 | |
High: >20% | 24 | 39 | 38.1% | 11.8 | |
Total | 140 | 2680 | |||
CDR and CRP >30 | |||||
Low: 0 | 4 | 568 | 0.7% | 0.14 | |
Mod: 1 to 2 | 73 | 1829 | 3.8% | 0.76 | |
High: ≥3 | 63 | 283 | 18.2% | 4.26 | |
Total | 140 | 2680 |