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De berekening van de kans op 5 aandoeningen wordt gemaakt op basis van resultaten uit 28 betrouwbare studies. Het algoritme extraheert deze gegevens uit de database en berekent nakansen aan de hand van voorkansen en positieve en negatieve likelihoodratio's. De uitkomst van de berekening is uiteraard een statistische inschatting en onderhevig aan diverse onzekerheden. Lees over de belangrijke statistische tekortkomingen.

Anamnese

Piepende ademhaling
Hoest
Roken
Andere allergische aandoening
Rillingen
Sputum
Familale voorgeschiedenis van allergie
Dyspnoe
Koorts

Klinische tekens

Wheezing bij auscultatie
SpO2 < 90%
Egofonie
Cyanosis
Demping bij percussie
Verminderd vesiculair ademgeruis
FEV1 < 80
SpO2 < 95%
Pols > 100 / min
Aandrukbare pijn borstkas
Intercostale intrekkingen
Ademhalingsfrequentie > 40 / min
Crepitaties
Neusvleugelen

Aanvullend

CRP > 250 mg/l
Long echografie
Rx thorax
CRP > 100 mg/l

Voorkansen

Nakansen




Studies gebruikt in deze berekening

1.ITS Yu et al. Using child reported respiratory symptoms to diagnose asthma in the community. Arch Dis Child 2004;89:544–548.
2.Tomita K et al. A scoring algorithm for predicting the presence of adult asthma: a prospective derivation study. Prim Care Respir J. 2013 Mar;22(1):51-8
3.Dewar M et al. Chronic Obstructive Pulmonary Disease: Diagnostic Considerations. Am Fam Physician. 2006 Feb 15;73(4):669-676
4.Rambaud-Althaus C et al. Waarde van symptomen en klinische tekens voor de diagnose van pneumonie bij kinderen. Minerva 2015 Volume 14 Nummer 6, 66 - 67
5.Amalakanti S et al. Pulse Oximetry Overestimates Oxygen Saturation in COPD. Respir Care 2016;61(4):423–427
6.Pachon EG et al. Can pulse oximetry select patients for screening spirometry? Primary Care Respiratory Journal (2004); 13 : 155 – 158
7.Moore M et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study. European Respiratory Journal 2017 50: 1700434
8.Holm A et al. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Br J Gen Pract. 2007 Jul 1; 57(540): 547–554
9.Heckerling PS et al. Clinical prediction rule for pulmonary infiltrates. Annals of Internal Medicine 1990 November 1, 113 (9): 664-70
10.Shah SN et al. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review. JAMA. 2017 Aug 1;318(5):462-471
11.Saldias PF et al. Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults. Rev Med Chil. 2007;135:143–150
12.Diehr P et al. Prediction of pneumonia in outpatients with acute cough–a statistical approach. J Chronic Dis. 1984;37:215–25
13.Melbye H et al. Diagnosis of pneumonia in adults in general practice. Relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference stan- dard. Scand J Prim Health Care. 1992;10:226–33
14.Kern DG et al. Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction. Chest. 1991;100:636–9
15.Gennis P et al. Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgen- ograms in the emergency department. J Emerg Med. 1989;7:263–8
16.Zanco J et al. Analysis of chest x-ray and clinical finding in children with pneumonia. Med. Sci., Vol. 17, No. (2), 2013 477-481
17.Laursen CB et al. Diagnostic performance of chest X-ray for the diagnosis of community acquired pneumonia in acute admitted patients with respiratory symptoms. Scand J Trauma Resusc Emerg Med. 2013; 21(Suppl 2): A21
18.Ticinesi A et al. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Medicine: July 2016 - Volume 95 - Issue 27 - p e4153
19.Nazerian P et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med. 2015 May;33(5):620-5
20.Ianniello S et al. First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up. The British Journal of Radiology 2016 89:1061
21.Bourcier JE et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. American Journal of Emergency Medicine 32 (2014) 115–118
22.Xia Y et al. Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis. Journal Of Thoracic Disease, 8(10), 2822-2831
23.Koster MJ et al. Diagnostic properties of C-reactive protein for detecting pneumonia in children. Respiratory Medicine Volume 107, Issue 7, July 2013, 1087-1093
24.Le Bel J. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan. Crit Care. 2015; 19: 366
25.To T et al. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health. 2012; 12: 204
26.Snoeck-Stroband JB et al. NHG Standaard COPD. Huisarts Wet 2015;58(4):198-211
27.NICE clinical guideline: Pneumonia scope (September 2012)
28.Pneumonia among Children in Developing Countries: DBMD


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