Diagnostic accuracy of clinical symptoms in obstructive airway diseases varied within different health care sectors.
OBJECTIVE
To determine the diagnostic accuracy and diagnostic patterns of clinical symptoms in patients suspected to suffer from obstructive airway diseases (OADs) within different health care sectors.


METHODS
Ten general practices (219 patients), one practice of pneumologists (259 patients) and one specialist hospital (300 patients). Sensitivities, specificities, positive (LR+), and negative (LR-) likelihood ratios of clinical symptoms were compared with lung function testing.


RESULTS
Thirty-one percent had chronic obstructive pulmonary disease (COPD), 21% had asthma. Sensitivities increased and specificities decreased from outpatient to hospital setting. The multivariate model of adjusted likelihood ratios for COPD showed LR+=4.86 (95% confidence interval [CI]=2.09-11.29) and LR-=0.07 (95% CI=0.01-0.43) of the combination "wheezing," "dyspnea when going upstairs," "smoking" in general practice. In hospital, the combination "dyspnea when going upstairs," "dyspnea during minimal exercise," and "smoking" showed LR+=3.34 (95% CI=2.08-5.31) and LR-=0.02 (95% CI=0.01-0.12). The combination "no coughing," "dyspnea attacks," and "no smoking" showed LR+=4.08 (95% CI=1.67-10.4) and LR-=0.24 (95% CI=0.12-0.58) for asthma in general practice. The combination "dyspnea attacks" and "no dyspnea when walking" showed LR+=6.48 (95% CI=1.01-40.94) and LR-=0.28 (95% CI=0.11-0.75) for asthma in hospital.


CONCLUSIONS
Clinical decision rules for OAD need to be derived from original studies in their respective settings or assessed on their transferability to other settings.
Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Orleansstrasse 47, 81667 München, Germany. antonius.schneider@lrz.tum.de
Antonius
A
Schneider
Mehtap
M
Ay
Bernhard
B
Faderl
Klaus
K
Linde
Stefan
S
Wagenpfeil
D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis; D003661:Decision Support Techniques; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data; D019981:Health Care Sector / Q000592:standards* / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015272:Pulmonary Medicine / Q000592:standards / Q000706:statistics & numerical data; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity