Kumar 2011.

Clinical features and settings	Hospital setting (Lok Nayak Hospital, India) Clinical features for study inclusion: cough and fever with breathlessness of less than 30 days duration, increased respiratory rate on examination, signs of consolidation or bronchopneumonia with or without wheeze on auscultation, radiological findings suggestive of consolidation, bronchopneumonia or interstitial infiltrates with or without hyperinflation
Participants	Children aged 2 months to 12 years admitted to hospital with lower respiratory tract infections Number of participants: 200 Male participants: 127 (63.5%) Number of participants with M. pneumoniae: 71 (35.5%)
Study design	Prospective observational cohort study
Target condition and reference standard(s)	M. pneumoniae detected using: serological testing of acute and convalescent blood samples (ELISA for IgM and IgG antibodies to M. pneumoniae). Serological evidence of M. pneumoniae infection was defined as presence of M. pneumoniae‐specific IgM or IgG or fourfold rise in IgG titre between acute and convalescent sera PCR analysis of nasopharyngeal aspirates Presence of M. pneumoniae infection was defined as M. pneumoniae detected using either or both laboratory methods
Index and comparator tests	Symptoms: cough, coryza, afebrile Signs: wheeze audible on auscultation
Follow‐up	Duration of follow‐up not reported
Notes
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Unclear	Co‐morbidities in study population were not reported. Did not state whether or not children with co‐morbidities were excluded
Acceptable reference standard? All tests	Yes	Children with positive PCR results but negative serology results were still diagnosed with M. pneumoniae. However, there was good agreement between PCR and serology results; 20 children had positive PCR results of whom only 3 did not also have serological evidence of M. pneumoniae infection
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	All study participants were subjected to the same laboratory tests
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	Unclear	Laboratory criteria/thresholds for serological diagnosis of M. pneumoniae detection were not reported
Relevant clinical information? All tests	Unclear	Baseline data on participant age and sex were collected. However, unclear whether data on duration of illness were collected at the time of study entry
Uninterpretable results reported? All tests	Yes	Three children had positive PCR results without serological evidence of M. pneumoniae infection
Withdrawals explained? All tests	Yes	Data reported for all 200 participants; no withdrawals reported