Value of clinical signs in the identification of Mycoplasma pneumonia in community acquired pneumonia in children / 中华儿科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the value of clinical signs in the identification of Mycoplasma pneumonia in children's community acquired pneumonia.</p><p><b>METHOD</b>We searched the Cochrane library, PubMed, CNKI, Wan Fang and VIP databases. According to the inclusion and exclusion criterias, we selected and extracted the related information in the literature. According to the QUADAS evaluation system, we established the quality evaluation standard to evaluate the quality of the included studies and analyzed the difference of the clinical manifestations between Mycoplasmae pneumoniae and non-Mycoplasma pneumoniae in children's community acquired pneumonia. We used the RevMan 5.3 software to do the meta-analysis and collected the data according to the requirements. We calculated the pooled sensitivities, specificities and 95%CIs. Then we calculated the negative and positive likelihood ratio, the ratio of the diagnosis and the pre-/post-test probabilities with 95% CIs.</p><p><b>RESULT</b>A total of 11 articles were included in the literature. In summary, the cases of the clinical signs of true positive (TP) and false positive (FP) were as follows chest pain TP 287, FP 1090; rales TP 1906, FP 6886; headache TP 590, FP 2051; pleural effusion TP 10, FP 16; consolidation TP 75, FP 83; emphysema TP 443, FP 116. The pooled sensitivity, the pooled specificity, the diagnostic ratio (DOR) and 95% CI were chest pain pooled sensitivity 0.12, 95% CI 0.10-0.13, pooled specificity 0.89, 95% CI 0.88-0.90, DOR 1.05, 95% CI 0.92-1.21; rales pooled sensitivity 0.66, 95% CI 0.64, 0.67, pooled specificity 0.36, 95% CI 0.35, 0.37, DOR 1.12, 95% CI 1.02, 1.22; headache pooled sensitivity 0.23, 95% CI 0.21-0.25, pooled specificity 0.80, 95%CI 0.79-0.80, DOR 1.16, 95%CI 1.05-1.29; pleural effusion pooled sensitivity 0.04, 95% CI 0.02, 0.08, pooled specificity 0.98, 95% CI 0.96, 0.99, DOR 1.28, 95% CI 0.56, 2.89; consolidation pooled sensitivity 0.32, 95% CI 0.26, 0.39, pooled specificity 0.87, 95% CI 0.84, 0.90, DOR 1.88, 95% CI 1.23, 2.90; emphysema pooled sensitivity 0.22, 95% CI 0.17, 0.29, pooled specificity 0.73, 95% CI 0.69, 0.77, DOR 1.05, 95% CI 0.68, 1.61.</p><p><b>CONCLUSION</b>The value of clinical symptoms and signs in the identification of mycoplasma pneumonia in children's community acquired pneumonia was not significant. Although the clinical symptoms/signs of chest pain, headache, rales and chest X-ray manifestations of pleural effusion, consolidation, emphysema could suggest Mycoplasma pneumoniae infection, the presence or absence of any clinical signs were not positive or negative indicators for the identification of Mycoplasma pneumoniae infections.</p>