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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The diagnostic value of history and physical examination for COPD in suspected or known cases: a systematic review

BD Broekhuizen, AP Sachs, R Oostvogels, AW Hoes, TJ Verheij, and KG Moons.

Review published: 2009.

Link to full article: [Journal publisher]

CRD summary

This review concluded that there was insufficient evidence to assess the value of history taking and physical examination for diagnosing chronic obstructive pulmonary disease. Given the paucity of studies, the authors' conclusions seem appropriate. However, the authors excluded non-English language studies and did not search specifically for unpublished studies, so the conclusions may not represent the entire evidence base.

Authors' objectives

To evaluate the diagnostic value of history taking and physical examination in recognising chronic obstructive pulmonary disease (COPD).

Searching

PubMed, EMBASE, the Cochrane Library, CINAHL, Clinical Evidence and the Medion Database were searched for English language studies from inception to September 2008; search terms were reported. Reference lists of retrieved studies were also scanned.

Study selection

Diagnostic accuracy studies comparing history taking and/or physical examination with a reference test of spirometry, where the cut-off values for a positive test were clearly defined, were eligible for inclusion.

The definition of COPD varied across studies, as did the setting in which the study was conducted. The age of participants ranged from 18 to 85 years, and the proportion of males from 38% to 98%. The aspects of clinical history and physical examination evaluated also varied across studies, as did the cut-off points for the reference standard.

Full text papers were screened by three independent reviewers; the authors did not state how many reviewers screened the titles and abstracts.

Assessment of study quality

Two independent reviewers assessed study quality using the 14-criteria QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool; disagreements were resolved by a third reviewer.

Data extraction

Sensitivity, specificity, and positive and negative likelihood ratios were either extracted or calculated. The results from univariate and multivariate analysis for each aspect of history taking and physical examination reported were also extracted; where reported, diagnostic outcomes were provided from studies with univariate analysis, and odds ratios (OR), without a measure of variance, for studies using a multivariate analysis.

Trialists were contacted for additional data. Two reviewers independently extracted data; disagreements were resolved by discussion or recourse to a third reviewer.

Methods of synthesis

The studies were combined in a narrative synthesis. Differences between studies were discussed in the text, and brief study details and the results of univariate and multivariate analyses presented in tables.

Results of the review

Six studies met the inclusion criteria (n=1,861 patients; range 161 to 703). All six studies clearly described their selection criteria, used an adequate reference standard, avoided verification and incorporation bias, and reported reasons for withdrawals. Four studies clearly recruited a representative sample, four blinded investigators when interpreting results, but only one reported uninterpretable/intermediate results.

Patient history: Eight patient history tests demonstrated independent diagnostic value for chronic obstructive pulmonary disease (COPD): over 45 years of age (one study), female (one study), difficulty breathing (two studies), wheezing (two studies), smoking (two studies) , previous consultation for cough or wheezing (one study), self-report history of COPD (one study), and allergy symptoms (one study). Family history of asthma was not of independent diagnostic value.

Physical examination: Five physical examination tests demonstrated independent diagnostic value for COPD: wheezing, forced expiratory time nine seconds and six seconds, maximum laryngeal height and prolonged expiration, all in single studies. Reduced breath sounds, rales/rhonchi, laryngeal descent, Hoover sign and clinical impression were not of independent diagnostic value.

Authors' conclusions

There was insufficient evidence to assess the value of history taking and physical examination for diagnosing COPD.

CRD commentary

The authors addressed a clear research question, supported by appropriate inclusion criteria. Several relevant sources were searched, but COAD (chronic obstructive airways disease) was not used a search term. Also, there was no specific search for unpublished studies, and only English language studies were eligible, so publication and language bias may be present. Full paper screening, data extraction and quality assessment were conducted in duplicate, but it was unclear whether similar methods to reduce error and bias during the initial stage of study selection were employed.

Study quality was assessed using appropriate criteria. The decision to combine studies in a narrative synthesis seems appropriate given the heterogeneity across studies. The included studies avoided most of the biases assessed in QUADAS. Each variable of history taking and physical examination was examined in only one or two studies.

Given the paucity of studies assessing similar aspects of history taking and physical examination, the authors' conclusions seem appropriate.

Implications of the review for practice and research

Practice: The authors did not state implications for practice.

Research: The authors stated that future diagnostic accuracy studies on COPD are necessary to estimate the true diagnostic value of history taking and physical examination.

Funding

The Netherlands Organisation for Health Research and Development.

Bibliographic details

Broekhuizen BD, Sachs AP, Oostvogels R, Hoes AW, Verheij TJ, Moons KG. The diagnostic value of history and physical examination for COPD in suspected or known cases: a systematic review. Family Practice 2009; 26(4): 260-268. [PubMed: 19423699]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Medical History Taking; Middle Aged; Physical Examination; Pulmonary Disease, Chronic Obstructive /diagnosis /physiopathology; Young Adult

AccessionNumber

12009107876

Database entry date

03/03/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19423699

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