Deerojanawong 2006.
| Clinical features and settings | Multicentre study performed at 3 hospitals in Bangkok, Thailand (Queen Sirkit National Insititute of Health, King Chulalongkorn Memorial Hospital, Ramathibodi Hospital) Clinical features for study inclusion: clinical and radiological diagnosis of community‐acquired pneumonia, defined as new infiltrates or consolidation on chest X‐ray that could not be attributed to other aetiology and the presence of 3 or more of: cough, acute change in quality of sputum, fever or hypothermia (> 38 °C or < 36.1 °C) within the preceding 24 hours, rales or evidence of pulmonary consolidation, leukocytosis, malaise/myalgia or gastrointestinal symptoms |
|
| Participants | Children aged 2 to 15 years with community‐acquired pneumonia Children were excluded if they had evidence or history of tuberculosis, nosocomial pneumonia, aspiration pneumonia or bronchiectasis. Children were also excluded if they were HIV‐positive or had been hospitalised within 2 weeks prior to consultation Number of participants: 257 Number of participants who underwent testing for M. pneumoniae: 245 Male participants: 135, (55.1%) Number of participants with M. pneumoniae: 36, (14.7%) |
|
| Study design | Prospective observational cohort study | |
| Target condition and reference standard(s) |
M. pneumoniae detected using:
Results of single serum samples were excluded from the analysis. The presence of positive PCR for M. pneumoniae in the absence of a positive serologic response was interpreted as possible carriage |
|
| Index and comparator tests | Symptoms: cough, fever, chill, chest pain, dyspnoea, malaise, myalgia, diarrhea, wheezing Signs: rales, rhonchi, bronchial breath sounds |
|
| Follow‐up | Children followed up during admission. Duration between admission and recording of clinical features/initial sample taking was not reported | |
| Notes | In total, 199 children (81%) were treated in hospitals and 3 children (1%) required treatment in the intensive care unit | |
| Table of Methodological Quality | ||
| Item | Authors' judgement | Description |
| Representative spectrum? All tests | Yes | Inclusion criteria not based on indicators of disease severity. Co‐morbidities in study population: asthma (n = 51), congestive heart failure (n = 7), hepatic disease (n = 1), renal impairment (n = 1) |
| Acceptable reference standard? All tests | Yes | In total 36 children met laboratory diagnostic criteria for current M. pneumoniae infection; 24 children were diagnosed by a fourfold or greater increase in antibody titre between acute and convalescent sera and 12 were diagnosed by positive PCR with persistent high antibody titre. 16 children with a 4‐fold or greater increase in antibody titre were also positive by PCR |
| Acceptable delay between tests? All tests | Unclear | Timing of nasopharyngeal aspirate and acute blood sample collection in relation to recording of clinical features was not reported |
| Partial verification avoided? All tests | Yes | Of the 257 children enrolled in the study with a diagnosis of community‐acquired pneumonia, paired sera could only be obtained from 245 children |
| Differential verification avoided? All tests | Yes | All study participants were subjected to the same laboratory tests |
| Incorporation avoided? All tests | Yes | The diagnosis of M. pneumoniae was based on laboratory test results only |
| Reference standard results blinded? All tests | Yes | Clinical symptoms and signs were recorded during the acute community‐acquired pneumonia illness episode, when the results of convalescent serum samples would not have been available |
| Index test results blinded? All tests | Yes | Clear laboratory criteria for laboratory diagnosis of M. pneumoniae were reported |
| Relevant clinical information? All tests | Unclear | Baseline data on participant age, sex and co‐morbidity were recorded. However, unclear whether data on duration of illness were collected at the time of study entry |
| Uninterpretable results reported? All tests | Yes | Six children had positive PCR results without serological evidence of M. pneumoniae infection. These children were considered to be carriers of M. pneumoniae and were hence not classified as having current M. pneumoniae infection |
| Withdrawals explained? All tests | Yes | Explained that they were only able to obtain paired sera from 245/257 children. The 12 children from whom convalescent serum samples could not be obtained were excluded from the study population |