Abstract:Background: To predict the presence of asthma in adult patients with respiratory symptoms, we developed a scoring algorithm using clinical parameters.
“…Obstructive lung disease. Ten prospective observational studies, one retrospective observational study, and one cross-sectional study included patients with diagnosis of chronic obstructive lung disease (COPD) or asthma and compared auscultation with spirometry for the detection of airway obstruction [23][24][25][26][27][28][29][30][31][32][33][34] . The results listed Logeart et al 16 Chen et al 20 HPT Retrosp.…”
Section: Resultsmentioning
confidence: 99%
“…Tomita et al 34 www.nature.com/scientificreports www.nature.com/scientificreports/ in Table 2, show a poor diagnostic accuracy of auscultation for OLD. Table 3 shows that for the diagnosis COPD abnormal, decreased or absent breath sounds have a LR + of 4.3, with five available studies, and wheezes have a LR + of 3.6, with ten available studies (see also Supplementary Figure 4).…”
The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This metaanalysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.Diagnostic summary measures. The overall pooled sensitivity for lung auscultation is 37% (95% CI: 30-47%) and specificity 89% (95% CI: 85-92%) (see Table 2 and Fig. 2). Table 3 shows the pooled estimates of sensitivity and specificity for the different types of breath sounds: abnormal, decreased or absent breath sounds, crackles, rhonchi, and wheezes. Heterogeneity was significant when considering all outcomes (P < 0.001), but also when restricted to CHF, OLD and pneumonia. Only heterogeneity of study outcomes for HPT was not significant (P = 0.38). Deeks' Funnel Plot for all studies (Fig. 3) suggests publication bias (P = 0.01) when considering all outcomes. Publication bias was not significant, when restricting to CHF (P = 0.18), HPT (P = 0.34), OLD (P = 0.75) and pneumonia (P = 0.99). It must, however, be noted that the estimates of the bias when restricting to CHF and HPT were larger than the estimate of the bias based on all outcomes. Therefore, lack of significance for these pathology groups may be due to the small sample sizes (n = 10 and n = 6, respectively). Estimates of bias in the OLD and pneumonia subgroups were much smaller than the estimate of the bias based on all outcomes and sample sizes were larger compared to other subgroups (n = 22 and n = 29, respectively), suggesting the absence of publication bias for those pathology groups (see e- Fig. 1A-D).Congestive heart failure. Six prospective observational studies included patients with (acute) dyspnoea and compared auscultation with Doppler echocardiography, the Framingham criteria or by an expert panel for CHF [12][13][14][15][16][17] . Considering the res...
“…Obstructive lung disease. Ten prospective observational studies, one retrospective observational study, and one cross-sectional study included patients with diagnosis of chronic obstructive lung disease (COPD) or asthma and compared auscultation with spirometry for the detection of airway obstruction [23][24][25][26][27][28][29][30][31][32][33][34] . The results listed Logeart et al 16 Chen et al 20 HPT Retrosp.…”
Section: Resultsmentioning
confidence: 99%
“…Tomita et al 34 www.nature.com/scientificreports www.nature.com/scientificreports/ in Table 2, show a poor diagnostic accuracy of auscultation for OLD. Table 3 shows that for the diagnosis COPD abnormal, decreased or absent breath sounds have a LR + of 4.3, with five available studies, and wheezes have a LR + of 3.6, with ten available studies (see also Supplementary Figure 4).…”
The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This metaanalysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.Diagnostic summary measures. The overall pooled sensitivity for lung auscultation is 37% (95% CI: 30-47%) and specificity 89% (95% CI: 85-92%) (see Table 2 and Fig. 2). Table 3 shows the pooled estimates of sensitivity and specificity for the different types of breath sounds: abnormal, decreased or absent breath sounds, crackles, rhonchi, and wheezes. Heterogeneity was significant when considering all outcomes (P < 0.001), but also when restricted to CHF, OLD and pneumonia. Only heterogeneity of study outcomes for HPT was not significant (P = 0.38). Deeks' Funnel Plot for all studies (Fig. 3) suggests publication bias (P = 0.01) when considering all outcomes. Publication bias was not significant, when restricting to CHF (P = 0.18), HPT (P = 0.34), OLD (P = 0.75) and pneumonia (P = 0.99). It must, however, be noted that the estimates of the bias when restricting to CHF and HPT were larger than the estimate of the bias based on all outcomes. Therefore, lack of significance for these pathology groups may be due to the small sample sizes (n = 10 and n = 6, respectively). Estimates of bias in the OLD and pneumonia subgroups were much smaller than the estimate of the bias based on all outcomes and sample sizes were larger compared to other subgroups (n = 22 and n = 29, respectively), suggesting the absence of publication bias for those pathology groups (see e- Fig. 1A-D).Congestive heart failure. Six prospective observational studies included patients with (acute) dyspnoea and compared auscultation with Doppler echocardiography, the Framingham criteria or by an expert panel for CHF [12][13][14][15][16][17] . Considering the res...
“…Eight articles from seven studies met the review criteria and were included. 14–21 Fig. 1Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram…”
Diagnosing asthma is challenging. Misdiagnosis can lead to untreated symptoms, incorrect treatment and avoidable deaths. The best combination of clinical features and tests to achieve a diagnosis of asthma is unclear. As asthma is usually diagnosed in non-specialist settings, a clinical prediction model to aid the assessment of the probability of asthma in primary care may improve diagnostic accuracy. We aimed to identify and describe existing prediction models to support the diagnosis of asthma in children and adults in primary care. We searched Medline, Embase, CINAHL, TRIP and US National Guidelines Clearinghouse databases from 1 January 1990 to 23 November 17. We included prediction models designed for use in primary care or equivalent settings to aid the diagnostic decision-making of clinicians assessing patients with symptoms suggesting asthma. Two reviewers independently screened titles, abstracts and full texts for eligibility, extracted data and assessed risk of bias. From 13,798 records, 53 full-text articles were reviewed. We included seven modelling studies; all were at high risk of bias. Model performance varied, and the area under the receiving operating characteristic curve ranged from 0.61 to 0.82. Patient-reported wheeze, symptom variability and history of allergy or allergic rhinitis were associated with asthma. In conclusion, clinical prediction models may support the diagnosis of asthma in primary care, but existing models are at high risk of bias and thus unreliable for informing practice. Future studies should adhere to recognised standards, conduct model validation and include a broader range of clinical data to derive a prediction model of value for clinicians.
“…This study also found that certain subgroups are at greater risk of hospitalisation. It may be that those at risk of RTI-related hospitalisation could be defined in greater detail, thus enabling the development of a symptom-based scoring algorithm modelled on algorithms that already exist for many other conditions [11,25,26]. However, symptoms are not well recorded in routine records.…”
Section: Implications For Clinical Practice and Researchmentioning
Purpose Children with Down's syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS. Methods Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank-sum test was used to compare length of stay by RTI type and time-to-hospitalisation. Results RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62-1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82-6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19-2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls. Conclusions Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group.
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