ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2003
Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
87 citing papers in PubMed, 8 syntheses or guidelines pooled it, 232 citations in OpenAlex.
- Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care.The Cochrane database of systematic reviews · 2022Pooled it
- The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis.Scientific reports · 2020Pooled it
- Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review.Scientific reports · 2019Pooled it
- Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: a systematic review.Implementation science : IS · 2018Pooled it
- Pooled it
- Guidelines for the management of adult lower respiratory tract infections--full version.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2011Guideline
- Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review.BMJ (Clinical research ed.) · 2005Pooled it
- Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.Journal of the American Board of Family Medicine : JABFMPooled it
- Usefulness of C-reactive protein testing in acute cough/respiratory tract infection: an open cluster-randomized clinical trial with C-reactive protein testing in the intervention group.BMC family practice · 2014Trial
- Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study.BMJ (Clinical research ed.) · 2013Trial
- Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial.BMJ (Clinical research ed.) · 2009Trial
- Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC3T): study protocol of a cluster randomised controlled trial.BMC family practice · 2007Trial
- Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial.Annals of family medicineTrial
- Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial.Annals of family medicineTrial
- Out-of-hours C-reactive protein point-of-care testing and its association with long-term healthcare-seeking.Scandinavian journal of primary health care · 2026Article
- External validation of risk scores and multivariate models for the diagnosis of community-acquired pneumonia in outpatients.The European journal of general practice · 2026Article
- Independent risk factors for refractory mycoplasma pneumoniae pneumonia in children: a multivariate analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Clinical factors associated with CT-confirmed pneumonia in febrile patients: a retrospective study addressing verification bias with inverse probability weighting.BMC infectious diseases · 2026Observational
- ERS/ESCMID state-of-the-science statement on the role of rapid diagnostic tests for the diagnosis and management of community-acquired lower respiratory tract infections.The European respiratory journal · 2026Review
- The Value of NLR, PLR, MLR, and SII Combined with Lower Respiratory Tract Symptoms in Predicting Pulmonary Complications in Non-Risk-Factor Influenza A Patients.International journal of general medicine · 2026Article
27 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDiagnostic tests enabling general practitioners (GPs) to differentiate rapidly between pneumonia and other lower respiratory tract infections (LRTIs) are needed to prevent increase of bacterial resistance by unjustified antibiotic prescribing.
aimsTo assess the diagnostic value of symptoms, signs, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for pneumonia; to derive a prediction rule for the presence of pneumonia; and to identify a low-risk group of patients who do not require antibiotic treatment. DESIGN OF STUDY: Cross-sectional.
settingFifteen GP surgeries in the southern part of The Netherlands.
methodTwenty-five GPs recorded clinical information and diagnosis in 246 adult patients presenting with LRTI. Venous blood samples for CRP and ESR were taken and chest radiographs (reference standard) were made. Odds ratios, describing the relationships between discrete diagnostic variables and reference standard (pneumonia or no pneumonia) were calculated. Receiver operating characteristic analysis of ESR, CRP, and final models for pneumonia was performed. Prediction rules for pneumonia were derived from multiple logistic regression analysis.
resultsDry cough, diarrhoea, and a recorded temperature of > or = 38 degrees C were independent and statistically significant predictors of pneumonia, whereas abnormal pulmonary auscultation and clinical diagnosis of pneumonia by the GPs were not. ESR and CRP had higher diagnostic odds ratios than any of the symptoms and signs. Adding CRP to the final 'symptoms and signs' model significantly increased the probability of correct diagnosis. Applying a prediction rule for low-risk patients, including a CRP of < 20, 80 of the 193 antibiotic prescriptions could have been prevented with a maximum risk of 2.5% of missing a pneumonia case.
conclusionMost symptoms and signs traditionally associated with pneumonia are not predictive of pneumonia in general practice. The prediction rule for low-risk patients presented here, including a CRP of < 20, can considerably reduce unjustified antibiotic prescribing.
Indexed as
Identifiers
12830562PMC1314594W2091844397What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.