Diagnostic accuracy of clinical symptoms in obstructive airway diseases varied within different health care sectors

J Clin Epidemiol. 2012 Aug;65(8):846-54. doi: 10.1016/j.jclinepi.2011.12.014. Epub 2012 May 27.


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.

Study design and setting: 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.

Conclusion: Clinical decision rules for OAD need to be derived from original studies in their respective settings or assessed on their transferability to other settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asthma / diagnosis
  • Decision Support Techniques
  • Dyspnea / diagnosis
  • Female
  • General Practice / standards
  • General Practice / statistics & numerical data
  • Health Care Sector / standards*
  • Health Care Sector / statistics & numerical data
  • Hospitals, Special / standards
  • Hospitals, Special / statistics & numerical data
  • Humans
  • Likelihood Functions
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Medicine / standards
  • Pulmonary Medicine / statistics & numerical data
  • Respiratory Function Tests
  • Sensitivity and Specificity