Table 1 Characteristics of selected articles reporting on signs and/or symptoms

From: Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review

Nr. Author Setting % with pneumonia Age range Inclusion criteria Exclusion criteria Index test Reference standard
1 Ayalon et al.8 ED, Israel 34% 1 month–16 years CXR for suspicion of pneumonia Hospital-acquired pneumonia, aspiration pneumonia Signs and symptoms CXR
2 Craig et al.37 ED, Australia 3.4% ≤5 years Fever measured or reported by parents within previous 24 h Transferred from another hospital, cancer, transplant recipients Signs and symptoms CXR
3 Lynch et al.6 ED, Canada 35.7% 1–16 years CXR for suspicion of pneumonia Chronic respiratory disease, chronic congenital or complex cardiac disease, gastroesophageal reflux, sickle cell disease, malignancy, spastic quadriplegia, asthma requiring >1 bronchodilator treatment at ED, pneumonia in past 8 weeks, critically ill patients Signs and symptoms, vital signs CXR
4 Mahabee-Gittens et al.38 ED, USA 8.6% 2–59 months Cough and one of the following: labored, rapid, or noisy breathing; chest or abdominal pain; fever Currently taking antibiotics; treatment for smoke inhalation, foreign body aspiration, or chest trauma; known diagnoses of asthma, bronchiolitis, cystic fibrosis, sickle cell disease, or chronic cardiopulmonary disease Signs, symptoms and vital signs CXR
5 Nijman et al.39 ED, the Netherlands 6.7% 1 month–15 years Fever noted in 24 h before presentation or ≥38.0 °C at ED Chronic comorbidity, received antibiotics in the past week Signs and symptoms CXR, 1-week follow-up
6.1 Oostenbrink et al.35 ED, the Netherlands 16% 1 month–16 years Rectal temperature ≥38.0 °C and cough Immunodeficiency, multiple handicaps, pre-existing pulmonary disease Signs, symptoms, vital signs, WBC, CRP Composite: CXR, or follow-up, or review of records
6.2 Oostenbrink et al.35 ED, UK 14% 1 month–16 years Axillary temperature ≥38.0 °C and lower respiratory tract infection signs Immunodeficiency Signs, symptoms, vital signs, WBC, CRP Composite: CXR, or follow-up, or review of records
6.3 Oostenbrink et al.35 ED, UK 3.7% 1 month–16 years Fever reported or measured rectally ≥38.5 °C and acute breathing difficulty Immunodeficiency, multiple handicaps, admitted for resuscitation Signs, symptoms, vital signs, WBC, CRP Composite: CXR, or follow-up, or review of records
7 Rothrock et al.29 ED, USA 20% ≤5 years Presenting to ED, requiring CXR CXR obtained for trauma, foreign body ingestion, submersion injury Canadian task force guideline CXR
8 Shah et al.30 ED; USA 14.5% ≤5 years CXR for suspicion of pneumonia CXR for other indications than pneumonia, known illness that placed patient at greater risk of pneumonia Tachypnea CXR
9 Shah et al.34 ED, US 18% 0–21 years Clinically suspect of pneumonia, requiring CXR Hemodynamic instability Signs and symptoms CXR
10 Urbankowska et al.31 Dept. ped. pulmonology & allergy, Poland 72% >1 month Fever >38.0 °C, dyspnea, cough, and abnormal long auscultation Hospital acquired pneumonia, persistent abnormalities on former CXR, treated for pneumonia in the past 4 weeks Signs, symptoms, CRP, WBC CXR
11 Wingerter et al.32 ED; USA 16% ≤5 years CXR for suspicion of pneumonia Known illness that placed patient at greater risk of pneumonia WHO criteria for diagnosis of pneumonia CXR
12 Zukin et al.33 ED, USA 14% <17 years Clinically assessed need for CXR None Signs and symptoms CXR
  1. ED emergency department, CXR chest X-ray, WBC white blood cell count, CRP C-reactive protein