Signs and Symptoms

86 studies | 88,423 individuals
86 studies analysed the diagnostic accuracy of 20 different signs and symptoms in adults, 14 in children up to 14 years, and 9 below 5 years. Overall, the diagnostic accuracy of stand-alone signs and symptoms was poor in distinguishing bacterial and viral causes of infection.

Acute cough was the symptom with the highest sensitivity for influenza-like syndrome and bacterial pneumonia both in adults and children [flu-like syndrome: 90% (95% confidence interval (CI), 83% to 94%); bacterial pneumonia, adults: 89% (CI, 66% to 97%); bacterial pneumonia, children: 88% (CI, 67% to 97%)] but with very low specificity, especially for the diagnosis of bacterial pneumonia in adults [flu-like syndrome: 23% (CI, 13% to 39%); bacterial pneumonia, adults: 14% (CI, 2% to 48%); bacterial pneumonia, children: 18% (CI, 5% to 48%)].

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Forest plot and QUADAS evaluation
Abbreviations
  • ROC: receiver operating characteristic curve
  • CI: confidence interval