Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

IF 3.5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Health technology assessment Pub Date : 2024-10-02 DOI:10.3310/JLCP4570
Katie E Webster, Tom Parkhouse, Sarah Dawson, Hayley E Jones, Emily L Brown, Alastair D Hay, Penny Whiting, Christie Cabral, Deborah M Caldwell, Julian Pt Higgins
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Abstract

Background: Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus.

Methods: The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses.

Results: We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%).

Limitations: Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital).

Future work: Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs.

Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

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急性呼吸道感染护理点检测的诊断准确性:系统性综述。
背景:急性呼吸道感染是初级和急诊医疗服务中常见的就诊原因。识别细菌感染患者对于确保适当治疗至关重要。然而,避免过度处方抗生素以防止不必要的副作用和抗菌药耐药性也很重要。我们进行了一项系统性综述,总结了诊断成人细菌性呼吸道感染以及诊断两种常见呼吸道病毒(流感和呼吸道合胞病毒)的症状、体征和护理点检测诊断准确性的证据:主要方法是概述现有的系统综述。我们进行了文献检索(2023 年 5 月 22 日),以确定有关护理点检测诊断准确性的系统综述。在发现多篇综述的情况下,我们选择了最新、最全面的综述,其范围与我们的综述问题重合度最高。我们使用 "系统综述偏倚风险"(Risk of Bias in Systematic Reviews)工具对方法学质量进行了评估。提取诊断准确性(灵敏度、特异性或曲线下面积)的简要估计值。在未发现系统综述的情况下,我们搜索了主要研究。我们提取了足够的数据来构建诊断准确性的 2 × 2 表,以计算灵敏度和特异性。方法学质量采用诊断准确性研究质量评估第 2 版工具进行评估。在可能的情况下,我们进行了荟萃分析。我们使用 GRADE 评估现有综述和新分析中证据的确定性:我们确定了 23 篇综述涉及我们的综述问题;其中 6 篇被选为最全面且与我们的综述方案范围相似的综述。这些系统性综述考虑了细菌性呼吸道感染的以下检测方法:单个症状和体征;症状和体征组合(在临床预测模型中);包含 C 反应蛋白的临床预测模型;以及与感染相关的生物标记物(包括 C 反应蛋白、降钙素原等)。我们还发现了报告流感和呼吸道合胞病毒特定检测准确性的系统性综述。我们没有发现评估细菌性呼吸道感染白细胞计数诊断准确性的综述,也没有发现评估流感和呼吸道合胞病毒多重检测准确性的综述。因此,我们检索了主要研究,并对这些指标检测进行了荟萃分析。总体而言,我们发现症状和体征对细菌性呼吸道感染的诊断准确性较低(敏感性从 9.6% 到 89.1%;特异性从 13.4% 到 95%)。生物标志物的准确性稍好,尤其是在使用生物标志物组合时(灵敏度为 80-90%,特异性为 82-93%)。不同类型检测对流感或呼吸道合胞病毒的敏感性和特异性差异很大。涉及核酸扩增技术的检测(单一病原体或多重检测)对流感的诊断准确率最高(灵敏度 91-99.8%,特异性 96.8-99.4%):在使用 GRADE 进行评估时,大多数证据被认为确定性较低或非常低,原因包括效果估计不精确、可能存在偏差以及纳入了本综述范围之外的参与者(儿童或住院患者):目前的证据不足以支持在初级和急诊护理中常规使用护理点检测。进一步的工作必须确定引入护理点检测是增加了价值,还是仅仅增加了医疗成本:本文是由美国国家健康与护理研究所(NIHR)健康技术评估项目资助的独立研究,获奖编号为NIHR159948。
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来源期刊
Health technology assessment
Health technology assessment 医学-卫生保健
CiteScore
6.90
自引率
0.00%
发文量
94
审稿时长
>12 weeks
期刊介绍: Health Technology Assessment (HTA) publishes research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS.
期刊最新文献
Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews. The effect of two speech and language approaches on speech problems in people with Parkinson's disease: the PD COMM RCT. Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT. Transperineal biopsy devices in people with suspected prostate cancer - a systematic review and economic evaluation. Preventive drug treatments for adults with chronic migraine: a systematic review with economic modelling.
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