Clinical features for

diagnosis of
pneumonia in children
younger than 5 years: a
systematic review and
meta analysis
1.
Introduction

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Introduction

◎Identification and treatment is

fundamental
◎Chest radiograph isn’t available

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Pneumonia diagnosis (WHO)

Cough Fast breathing Chest indrawing

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Since 1980
No mayor innovation
in diagnosis
No accurate point of
care test to identify
who would benefit
from antibiotic
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2.
Methods

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Methods

Data
extraction
Search
strategy

Quality
assessme
nt

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Methods

Results

Statistical
analysis

Additional
analyses
on studies
in 1990s

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Search strategy

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 QUADAS-2

Quality Assessment

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Data extraction
◎Characteristic of study
◎Study population
◎Reference standard
◎Index test

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 Statistical
Analysis
◎Two by two table
◎Hierarchical random effects bivariate
logistic regression model (bivariate model)
◎Hierarchical summary receiver operation
characteristic (HSROC)

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 Additional
Analysis
◎Evidence for the WHO definition of clinical
pneumonia in the 1990s

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Result

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 Place your screenshot here

Study selection
process
.

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Characteristic
of Study

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 Characteristic of included study

setting 16 3 7 7 4 1
Low income countries USA outpatient emergency inpatient Community level

Inclusion criteria 5 7 6
cough Clinical suspicion Suspicion of
of pneumonia as pneumonia
per specified without specified
criteria criteria

57 different clinical features

78 index test 12 10 8 7 7 6 6
Fast Chest Nasal Elevated Crepitations History of Wheezing
breathing indrawing flaring temperature fever
QUADAS-2

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Statistical analysis

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Statistical analysis

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HSROC plots

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Discussion

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◎Difference in the ◎WHO decided to ◎Chest indrawing,
diagnostic accuracy use highly sensitive heterogeneous
of age related fast clinical criteria estimates of
breathing is ◎This study aimed sensitivities,
possibly due to the to identify children specificities, and
difference in that really need likelihood ratios.
reference standard abtibiotic treatment ◎Insufficient for
◎The clinical diagnosis of
outcome of children radiological
with WHO-non pneumonia
severe pneumonia ◎Useful to identify
didnt differ when children that are at
treated with risk of hypoxaemia
antibiotic or
placebo
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Conclusion

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No one clinical feature is sufficient on its
own for diagnosis of radiological
pneumonia

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 Combination
The development of the
clinical features with the
of innovative point
best likelihood ratios in
of care tests
a decision tree

Suggestion

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