SynthesisThe British journal of general practice : the journal of the Royal College of General Practitioners2019
Clinical gestalt to diagnose pneumonia, sinusitis, and pharyngitis: a meta-analysis.
Synthesis in The British journal of general practice : the journal of the Royal College of General Practitioners, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 43 citations in OpenAlex.
- Oral cavity swabbing for diagnosis of group a Streptococcus: a prospective study.BMC family practice · 2020Trial
- Assessing Risk of Early ICU Admission or Death at Emergency Department Triage: Clinical Judgment Versus Early Warning Scores.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Observational
- Development and Validation of a Prognostic Risk Score for Patients With Cancer and Neutropenic Fever Presenting to the Emergency Department.Journal of the American College of Emergency Physicians open · 2026Article
- Diagnosing acute lower respiratory tract infections in out-of-hours services during the COVID-19 pandemic.International journal of emergency medicine · 2025Article
- Moving from a pilot study to large pragmatic trial in primary care settings: A study on acute rhinosinusitis.Journal of clinical and translational science · 2025Article
- Article
- The diagnostic likelihood ratio function and modified test for trend: Identifying, evaluating, and validating nontraditional biomarkers in case-control studies.Statistics in medicine · 2023Article
- Decisions regarding antibiotic prescribing for acute sinusitis in Norwegian general practice. A qualitative focus group study.Scandinavian journal of primary health care · 2023Article
- Developing and Validating a Prediction Model For Death or Critical Illness in Hospitalized Adults, an Opportunity for Human-Computer Collaboration.Critical care explorations · 2023Article
- Derivation and validation of clinical prediction rules for diagnosis of infectious mononucleosis: a prospective cohort study.BMJ open · 2023Article
- ePOCT+ and the medAL-suite: Development of an electronic clinical decision support algorithm and digital platform for pediatric outpatients in low- and middle-income countries.PLOS digital health · 2023Article
- Ability of emergency medicine clinicians to predict COVID-19 in their patients.The American journal of emergency medicine · 2022Article
- Factors associated with C-reactive protein testing when prescribing antibiotics in general practice: a register-based study.BMC primary care · 2022Article
- Diagnosing community-acquired pneumonia via a smartphone-based algorithm: a prospective cohort study in primary and acute-care consultations.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Article
- Deep Learning for Identification of Acute Illness and Facial Cues of Illness.Frontiers in medicine · 2021Article
- Pancreatic Islets and Gestalt Principles.Diabetes · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe overall clinical impression ('clinical gestalt') is widely used for diagnosis but its accuracy has not been systematically studied.
aimTo determine the accuracy of clinical gestalt for the diagnosis of community-acquired pneumonia (CAP), acute rhinosinusitis (ARS), acute bacterial rhinosinusitis (ABRS), and streptococcal pharyngitis, and to contrast it with the accuracy of clinical decision rules (CDRs). DESIGN AND
settingSystematic review and meta-analysis of outpatient diagnostic accuracy studies in ambulatory care.
methodPubMed and Google were searched for studies in outpatients that reported sufficient data to calculate accuracy of the overall clinical impression and that used the same reference standard. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and measures of accuracy calculated using bivariate meta-analysis.
resultsThe authors identified 16 studies that met the inclusion criteria. The summary estimates for the positive (LR+) and negative likelihood ratios (LR-) were LR+ 7.7, 95% confidence interval (CI) = 4.8 to 11.5, and LR- 0.54, 95% CI = 0.42 to 0.65 for CAP in adults, LR+ 2.7, 95% CI = 1.1 to 4.3 and LR- 0.63, 95% CI = 0.20 to 0.98 for CAP in children, LR+ 3.0, 95% CI = 2.1 to 4.4 and LR- 0.37, 95% CI = 0.29 to 0.46 for ARS in adults, LR+ 3.9, 95% CI = 2.4 to 5.9 and LR- 0.33, 95% CI = 0.20 to 0.50 for ABRS in adults, and LR+ 2.1, 95% CI = 1.6 to 2.8 and LR- 0.47, 95% CI = 0.36 to 0.60 for streptococcal pharyngitis in adults and children. The diagnostic odds ratios were highest for CAP in adults (14.2, 95% CI = 9.0 to 21.0), ARS in adults (8.3, 95% CI = 4.9 to 13.1), and ABRS in adults (13.0, 95% CI = 5.0 to 27.0), as were the C-statistics (0.80, 0.77, and 0.84 respectively).
conclusionThe accuracy of the overall clinical impression compares favourably with the accuracy of CDRs. Studies of diagnostic accuracy should routinely include the overall clinical impression in addition to individual signs and symptoms, and research is needed to optimise its teaching.
Indexed as
Identifiers
What 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.