|
ARI Upper tract
|
13 |
Gulich et al., 199913 Gulich MS, Matschiner A, Glück R, Zeitler HP. Improving diagnostic
accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein
(CRP). Br J Gen Pract. 1999;49(439):119-21., Germany |
To assess whether the measurement of CRP improves the accuracy of diagnosis of
pharyngitis |
CRP and leukocyte count in
the blood |
Cross-sectional |
Phase I: 179 Phase II:161;16-75; 34.3 |
15 phase I 14 phase II |
Improvement in accuracy from 70 to 81% when they had access to exams.
The ROC curve showed that
the diagnostic value of CRP
was better than the leukocyte counts (area under the curve = 0.85 versus
0.68) |
| 14 |
Bjerrum et al., 200414 Bjerrum L, Gahrn-Hansen B, Munck AP. C-reactive protein measurement in
general practice may lead to lower antibiotic prescribing for sinusitis. Br J Gen
Pract. 2004;54(506):659-62.,
Denmark |
To assess whether generalists using CRP in their practice prescribe fewer antibiotics for
sinusitis that generalists who do not |
CRP
|
Cross-sectional |
1,444;31-53;40 |
367 |
Physicians who requested the test prescribed 20% fewer antibiotics. The
request and the level of CRP had a strong influence on prescribing antibiotics for
sinusitis |
| 15 |
Capper et al., 200115 Capper R, Canter RJ. Is there agreement among general practitioners,
paediatricians and otolaryngologists about the management of children with recurrent
tonsillitis? Clin Otolaryngol Allied Sci. 2001;26:371-8., United
Kingdom |
To assess agreement between general practitioners, pediatricians and ENT
specialists on the conduct among children with recurrent tonsillitis |
Non previously validated questionnaire answered by doctors |
Cross-sectional |
Does not apply |
71 GPs, 57 pediatricians, 42 ENT specialists |
Little agreement among GPs, pediatricians and ENT specialists about the
diagnosis of tonsillitis and indication for tonsillectomy |
|
ARI Lower tract
|
11 |
Hopstaken et al., 200211 Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ.
Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive
protein to a diagnosis of pneumonia in acute lower respiratory tract infection. Br J
Gen Pract. 2003;53(490):358-64.,
Netherlands |
To evaluate the diagnostic value of signs, symptoms, ESR and CRP for pneumonia |
Chest X-ray |
Cross-sectional |
246; 18-89; 52 |
25 |
Of the 246 patients included, 32 (13%) had radiographs consistent with
pneumonia. GPs diagnosed pneumonia in 21 patients using only clinical
examination. Antibiotics were prescribed for 193 (78.4%) patients. The
authors concluded that the prescriptions could have been avoided in 80
(41%) patients with probable diagnosis of acute bronchitis who received
unnecessary antibiotics |
|
ARI Upper and lower tract
|
12 |
Briel et al., 200812 Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, Périat P,
et al. Procalcitonin-guided antibiotic use vs a standard approach
for acute respiratory tract infections in primary care. Arch Intern Med.
2008;1681:2000-7.,
Switzerland |
To compare the usual approach to approach guided by PCT(5) |
PCT
|
Randomized trial |
458;33-63; 48 |
53 |
The 458 patients with acute respiratory infections that, in their
physicians’ opinion, needed antibiotics were randomized to either a group
of usual care or a group of care guided according to the results of
PCT. When PCT was used
by GPs as a discriminating factor in relation to clinical assessment,
those who used it received 72% less antibiotic prescriptions than the
other group |
|
Tuberculosis
|
16 |
Cirit et al., 200316 Cirit M, Orman A, Unlü M. Physicians approach to the diagnosis and
treatment of tuberculosis in Afyon, Turkey. Int J Tuberc Lung Dis.
2003;7:243-7., Turkey |
Assessment of knowledge of GPs and pulmonary specialists on diagnosis
and treatment of tuberculosis |
Analysis of a questionnaire completed by professionals |
Cross-sectional |
Does not apply |
203 |
Significant difference on knowledge of the diagnosis and treatment of
tuberculosis among specialists and generalists in primary care. The main
differences were in combination of drugs for treatment, infection
duration, and medical management in cases of resistance |
| 17 |
Al-Maniri et al., 200817 Al-Maniri AA, Al-Rawas OA, Al-Ajmi F, De Costa A, Eriksson B, Diwan VK.
Tuberculosis suspicion and knowledge among private and public general practitioners:
Questionnaire Based Study in Oman. BMC Public Health. 2008;26:177., Oman |
To evaluate suspicion of tuberculosis by GPs in units of public and
private health |
Questionnaire related to five clinical cases |
Cross-sectional |
Does not apply |
257 |
The general index of suspicion was only 37.7% of GPs and public
hospitals had a better degree of suspicion compared to private units
(27.3 versus 53.4%, p = 0.001) |
| 18 |
Hong et al.,199518 Hong YP, Kwon DW, Kim SJ, Chang SC, Kang MK, Lee EP, et al. Survey of
knowledge, attitudes and practices for tuberculosis among general practitioners.
Tuber Lung Dis. 1995;76:431-5., South
Korea |
Knowledge, attitudes and practices of GPs |
Responses to questionnaire |
Cross-sectional |
Does not apply |
923 |
More than 50% do not considerthe sputum examination essential for
diagnosis, and 75% to monitor response to treatment. For initial
treatment of active tuberculosis, only 11% prescribed in accordance with
government guidelines. More than 73% were using treatment regimens that
are not recommended and 1 6% unacceptable regimes |
| 19 |
Singla et al., 199819 Singla N, Sharma PP, Singla R, Jain RC. Survey of knowledge, attitudes
and practices for tuberculosis among general practitioners in Delhi, India. Int J
Tuberc Lung Dis. 1998;2:384-9., India |
Knowledge, attitudes and practices of doctors in the private system |
Responses to questionnaire |
Cross-sectional |
Does not apply |
204 |
In suspected cases of tuberculosis only 22 (1 2%) of GPs requesting
sputum AFB smear for
diagnosis. Only 66 (18%) search contacts, and 39 (19.5%) guide the
patient to regular treatment |
|
Asthma
|
20 |
Marklund et al., 199920 Marklund B, Tunsater A, Bengtsson C. How often is the diagnosis
bronchial asthma correct? Fam Pract. 1999;16:112-6.,
Sweden |
To estimate the frequency of diagnostic errors in asthma by GPs |
Review by allergy specialist, spirometry and bronchial challenge test
whenever there is diagnostic uncertainty |
Cross-sectional |
123; >18 years; no reports |
6 |
One hundred and twenty three patients completed the inclusion criteria
and were invited for further consultation. Eighty six of these (70%)
accepted the invitation. At the end, 51/86 (59%) had asthma, six (7%) had
asthma combined with COPD, and 29 (34%) had no asthma |
| 21 |
Montnemery et al., 200221 Montnémery P, Hansson L, Lanke J, Lindholm L-H, Nyberg P, Löfdahl C-G,
et al. Accuracy of a first diagnosis of asthma in primary health care. Fam Pract.
2002;19:365-8.,
Sweden |
Assess whether the low prevalence of asthma was caused by underdiagnosis
in primary care. The study also assessed the validity of the first
diagnosis of asthma by GPs in primary care |
Evaluated by pulmonary specialists |
Cross-sectional |
3,025; ≥18 years; no reports |
100 |
99 patients were diagnosed with asthma and were reevaluated by
pulmonologists. The diagnosis of asthma was validated on 52 cases
(76.5%), with a sensitivity of 0.59 (95% Cl 0.31-0.81) and specificity of
0.99 (95% CI-0.99-1.00). These results indicated that 23.5% of patients
were diagnosed as asthmatic by GPs without actually having the
disease |
| 9 |
Adams et al., 20039 Adams R, Wilson D, Appleton S, Taylor A, Dal Grande E, Chittleborough C,
et al. Underdiagnosed asthma in South Australia. Thorax.
2003;58:846-50.,
Australia |
To compare the clinical diagnosis of asthma by GPs with spirometry |
Spirometry |
Cross-sectional |
3,422; ≥18 years; no reports |
Not informed |
Of the 3,422 individuals interviewed, 2,523 (74%) agreed to participate
in the clinical assessment, and 292 (11.6%) had asthma according to
spirometric criteria. Of this total, 236 (9.3%) had a previous,
self-reported, diagnosis of asthma, and 56 (2.3%) were unaware of the
diagnosis and were defined as having asthma according to spirometric
criteria. Thus, the group diagnosed with asthma by spirometry, 56(19.2%)
had no previous diagnosis of asthma |
| 10 |
Hahn et al., 199410 Hahn DL, Beasley JW and the Wisconsin Research Network (WReN) Asthma
Prevalence Study Group. Diagnosed and possible undiagnosed asthma: A Wisconsin
Research Network (WReN) Study. J Fam Pract. 1994;38:373-9., United
States |
Describe the epidemiology of diagnosis, and the possible underdiagnosis
of asthma |
Responses to questionnaire |
Cross-sectional |
14,127; All age groups; 15 |
59 |
Of the total sample, 13,542 (95.5%) answered the questionnaire properly.
Of this total, 10.3% reported having previous medical diagnosis of
asthma. The study revealed that 6.5% of patients who had wheezing had no
previous diagnosis of asthma (underdiagnosis) |
| 22 |
Ward et al., 200422 Ward DG, Halpin DM, Seamark DA. How accurate is a diagnosis of asthma in
a general practice database? A review of patients' notes and questionnaire-reported
symptoms. Br J Gen Pract. 2004;54:753-8., United
Kingdom |
Assessed the under- and overdiagnosis of asthma in patients aged 1 6-55
years in primary care |
Analysis of questionnaire answered by the patients themselves |
Cross-sectional |
833 patients and 831 controls; 16-55; 34.3 average |
8 |
The response rate was 79.1 % (659/833). Among the respondents, 60.5%
(399/659) had symptoms of bronchial hyperactivity; among those without
bronchial hyperactivity, 73.1 % (190/260) were considered asthmatic
according to a review of their medical records. The authors concluded
that there is a chance of 89.4% that patients with this diagnosis
reported in their medical records do in fact have asthma |
|
COPD
|
23 |
Bednarek et al., 200823 Bednarek M, Maciejewski J, Wozniak M, Kuca P, Zielinski J. Prevalence,
severity and underdiagnosis of COPD in the primary care setting. Thorax.
2008;63:402-7.,
Poland |
To investigate the prevalence and severity of COPD in primary units |
Responses to a questionnaire and spirometry |
Cross-sectional |
2,250; 40-93; 56.7 |
2 |
Out ofthe 183 (9.3% of total) patients diagnosed with COPD based on
responses to a questionnaire and spirometry, only 34 (18.6%) had a
previous diagnosis |
| 24 |
Geijer et al., 200524 Geijer RM, Sachs AP, Hoes AW, Salomé PL, Lammers JW, Verheij TJ.
Prevalence of undetected persistent airflow obstruction in male smokers 40-65 years
old. Fam Pract. 2005;22:485-9.,
Netherlands |
To determine the prevalence of underdiagnosis of airflow obstruction
according to the GOLD criteria
|
Responses to a questionnaire and spirometry |
Cross-sectional |
3,985; 40-65; 50 |
Not informed |
Among the 702 who responded and possessed an acceptable and reproducible
spirometry, 201 (29.9%) had an obstructive pattern not previously
detected |
| 26 |
Roberts et al., 200926 Roberts CM, Abedi MKA, Barry JS, Williams E, Quantrill SJ. Predictive
value of primary care made clinical diagnosis of chronic obstructive pulmonary
disease (COPD) with secondary care specialist diagnosis based on spirometry performed
in a lung function laboratory. Prim Health Care Res Dev. 2009;10:49 AM
53., United
Kingdom |
To define the predictive value of clinical diagnosis or suspicion of
COPD in primary care patients presenting spirometric criteria for
diagnosis according to GOLD
|
Spirometry |
Cross- sectional |
677; Not defined; 63.8 |
Not informed |
Ofthe 503 who had clinical diagnosis and were referred for evaluation of
disease severity, 141 (28%) patients presented normal spirometry. The
remaining 302/503 (60%) had obstruction of air flow and possible COPD
according to the GOLD criteria, stage 2. The positive predictive value of the diagnosis of
COPD in primary care was 0.62 for patients referred for severity
assessment and 0.56 for patients referred for diagnostic testing |
| 27 |
Zwar et al., 201127 Zwar NA, Marks GB, Hermiz O, Middleton S, Comino EJ, Hasan I, et al.
Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in
general practice. Med J Aust. 2011;195:168-71., Australia |
Comparison ofthe clinical diagnosis of COPD in primary care GPs with
spirometry |
Spirometry |
Cross-sectional |
1,144; 40-80; 65 |
56 |
Ofthe 1,144 patients identified, 445 (38.9%) agreed to participate,
undergoing spirometry. Of these, 257 (57.8%) had spirometry consistent
with COPD; i.e., in this study, there was about 40% overdiagnosis and
many patients were treated unnecessarily |
| 28 |
Walters et al., 201128 Walters JA, Walters EH, Nelson M, Robinson A, Scott J, Turner P, et al.
Factors associated with misdiagnosis of COPD in primary care. Prim Care Respir J.
2011;20:396-402.,
Australia |
To evaluate the diagnostic errors of COPD in primary units |
Spirometry |
Cross-sectional |
1,200; Not informed; 65 |
31 |
Of the 1,200 patients identified, 341 (58%) underwent spirometry and 234
(69%) had a confirmed diagnosis. In 31% of cases, diagnostic errors were
found |
| 29 |
Hamers et al., 200629 Hamers R, Bontemps S, van den Akker M, Souza R, Penaforte J, Chavannes
N. Chronic obstructive pulmonary disease in Brazilian primary care: diagnostic
competence and case-finding. Prim Care Respir J. 2006;15:299-306., Brazil |
To assess the competence of GPs in primary care regarding the diagnosis
of COPD |
Spirometry |
Cross-sectional |
350; ≥15 years; 46.8 |
34 |
Of the 142 (44.9%) patients who underwent spirometry, 94 (66%) had been
correctly diagnosed by the GPs (Kappa = 0:55), nine with confirmed COPD
and 85 without COPD. The remaining 48 (34%) were discordant: 27 had COPD
accordingto the spirometry and were not diagnosed by the GPs, and 21 were
false positives |
| 30 |
Joo et al., 201130 Joo MJ, Au DH, Fitzgibbon ML, McKell J, Lee TA. Determinants of
spirometry use and accuracy of COPD diagnosis in primary care. J Gen Intern Med.
2011;26:1272-7., United
States |
To examine the characteristics associated with the use of spirometry in
primary care with increased risk for COPD and to determine the diagnostic
accuracy of spirometry in patients with COPD |
Spirometry |
Cohort |
1,052;≥ 35;57 |
Not informed |
A total of 1,052 patients were identified and 527 (50%) had spirometry.
Of the 159 patients identified as COPD, 93 (58.5%) met the GOLD
criteria. Of the 362
without a diagnosis of COPD, 93 (25.7%) had COPD according to the same
criteria. It was also found that chronic cough or dyspnea were more
associated with a request for spirometry than current or previous smoking
habits |
| 31 |
Hill et al., 201031 Hill K, Goldstein RS, Guyatt GH, Blouin M, Tan WC, Davis LL, et al.
Prevalence and underdiagnosis of chronic obstructive pulmonary disease among patients
at risk in primary care. CMAJ. 2010;182:673-8., Canada |
To measure the prevalence of COPD in patients aged over 40 years with a
smoking history |
Spirometry and clinical assessment |
Cross-sectional |
1,459; ≥40; 60 |
Not informed |
Of the 1,459 eligible patients, 1,003 underwent spirometry and completed
a questionnaire. Of these, 208 (20.7%) had spirometric criteria for COPD
accordingto GOLD 2,
FEV1/FVC<0.70,
and FEV1<0.80). Only 67
(32.7%) had a previous diagnosis of COPD |
|
Asthma and COPD
|
32 |
Pearson et al., 200332 Pearson M, Ayres J, Sarno M, Massey D, Price D. Diagnosis of airway
obstruction in primary care in the UK: the CADRE (COPD and Asthma
Diagnostic/management REassessment) programme 1997-2001. Int J Chron Obsruct Pulmon
Dis. 2006;1:435-43., United
Kingdom |
To assess the impact of spirometry and clinical evaluation in the
diagnosis of airway diseases |
Spirometry and questionnaire applied by the nursing staff |
Cross-sectional |
61,191; ≥40; 66.7 |
1,003 |
The evaluation showed improper base diagnosis with change in 54% of
diagnoses of asthma, COPD in 1 4% and 63% for other conditions |
| 33 |
Mel bye et al., 201133 Melbye H, Drivenes E, Dalbak L, Leinan T, Hoegh-Henrichsen S, Ostrem A.
Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and
spirometry in primary care patients aged 40 years or more. Int J Chron Obstruct
Pulmon Dis. 2011;6:597-603., Norway |
To describe symptoms and lung function in patients diagnosed with asthma
or COPD in primary care and to describe how the results of spirometry fit
the diagnoses made by GPs |
Spirometry |
Cross-sectional |
367; ≥40; 62 |
Not informed |
The diagnosis of COPD was confirmed by spirometry and according to
GOLD criteria in 68.1%
of patients, while the diagnosis of asthma was confirmed in 17.1%. The
kappa agreement between the diagnosis of COPD in the medical record with
the spirometric diagnosis was 0.50. Spirometry helped confirm that
patients had a mixed disease but did not discriminate between asthma and
COPD in all cases |
| 34 |
Izquierdo et al., 201034 Izquierdo JL, Martín A, Lucas P, Moro J, Almonacid C, Paravisini A.
Misdiagnosis of patients receiving inhaled therapies in primary care. Int J Chron
Obstruct Pulmon Dis. 2010;5:241-9.,
Spain |
Goal was to analyze the diagnostic accuracy in patients receiving
inhaled medications in primary care |
Spirometry |
Cross-sectional |
9,931; ≥18; 58.3 |
1,449 |
4,188 (42.9%) had a diagnosis of asthma, 4,175 (42.8%) had a diagnosis
of COPD, and 1,389 had non-identifiable diagnoses. Among patients aged
over 40 years with diagnoses of COPD and spirometry (50.9%), only 13.9%
met the GOLD criteria
|
| 35 |
Weidinger et al., 200935 Weidinger P, Nilsson JL, Lindblad U. Adherence to diagnostic guidelines
and quality indicators in asthma and COPD in Swedish primary care. Pharmacoepidemiol
Drug Saf. 2009;18:393-400.,
Sweden |
To assess adherence to guidelines in primary care in patients with
asthma and COPD |
Swedish national guidelines for asthma and COPD |
Cross-sectional |
623; All age groups; not informed |
Not informed |
Adhesion was found in 130/499 (26%) of patients with initial diagnosis
of asthma and 35/1 24 (28%) of patients with initial diagnosis of
COPD |
| 36 |
Raghunath et al., 200636 Raghunath A, Innes A, Norfolk L, Hannant M, Greene T, Greenstone M, et
al. Difficulties in the interpretation of lung function tests in the diagnosis of
asthma and chronic obstructive pulmonary disease. J Asthma.
2006;43:657-60., United
Kingdom |
To assess differences in the interpretation of spirometry and peak
expiratory flow (PEF) between primary care GPs and pulmonary specialists
in patients with a previous diagnosis of asthma or COPD |
Pulmonologists |
Cohort |
102;≥45 years; not informed |
Not informed |
The concordance between the diagnoses of generalists and specialists
(Kappa) in the evaluation of tests was 0.20 |
| 37 |
Starren et al., 201237 Starren ES, Roberts NJ, Tahir M, OByrne L, Haffenden R, Patel IS, et al.
A centralised respiratory diagnostic service for primary care: a 4-year audit. Prim
Care Respir J. 2012;21:180-6.;, United
Kingdom |
To checkthe operation of a unit of reference for respiratory conditions
by reviewing the diagnoses of referrals from GPs |
Pulmonologists |
Cross-sectional |
1,156; All age groups; 61.3 |
28 |
Ofthe 1,156 patients referred, COPD was the most common cause (445/666;
66.8%); over one third of the diagnoses suggested by GPs were incorrect
(161/445; 36%) |
| 38 |
Lucas et al., 201238 Lucas AE, Smeenk FJ, Smeele IJ, van Schayck OP. Diagnostic accuracy of
primary care asthma/COPD working hypotheses, a real life study. Respir Med.
2012;106:1158-63.,
Netherlands |
To assess what criteria GPs use to justify their diagnostic hypothesis
of asthma and COPD; whether the evaluations by experts cause changes in
diagnoses of GPs; and whether to make GPs justify their diagnostic
hypotheses, influences the diagnosis given in the reference center |
Pulmonologists |
Cross-sectional |
284; 2-88; 51 |
17 |
Only 50% of diagnostic hypotheses were confirmed by the specialized
service. The chances of asthma were confirmed more frequently (62%) than
those of COPD (40%). The justifications for the diagnostic hypotheses of
GPs did not influence the results |
| 39 |
Broekhuizen et al., 201039 Broekhuizen B, Sachs A, Hoes A, Moons K, Van Den Berg J, Dalinghaus W,
et al. Undetected chronic obstructive pulmonary disease and asthma in people over 50
years with persistent cough. Br J Gen Pract. 2010;60(576):489-94.,
Netherlands |
To determine the frequency of asthma or COPD in people aged over 50
years who consult their GPs because of persistent cough |
Panel with an experienced GP and a pulmonary specialist |
Cross-sectional |
353; >50; 63 |
73 |
After evaluation of pulmonary function tests and discussion of clinical
data by a panel oftwo doctors, it was concluded that 29% of patients had
a diagnosis of COPD, 7% had asthma, and 4% were diagnosed with mixed
disease. It should be reiterated that these diagnoses were new, that is,
they were not previous diagnoses made by assistant GPs |
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