Table (supplementary web data): Validity Assessment of Included Studies
Study ID
Inclusion criteria
Exclusion criteria
Aujesky 2005
[14]
Age >18, diagnosis of pneumonia with
radiographic pulmonary infiltrate
Hospital acquired pneumonia, immunosuppression, or
psychosocial problems incompatible with treatment
enrolment or follow up, pregnancy.
Barlow 2007
[15]
Receiving antibiotics for suspected lower
respiratory tract infection, new infiltrate
on chest radiograph or clinically
diagnosed with CAP
New pulmonary infiltration on radiograph
with at least one symptom or sign of
lower respiratory tract infection
HIV positive or immunosuppressed, potential
malignancy, age<16
Capelastegui
2006 [17]
Age >18 with diagnosis of CAP with
pulmonary infiltrates on chest radiograph
and symptoms
HIV positive, immunosuppressed or hospitalized for
the previous 14 days
Charles 2008
[18]
Age >18, chest radiograph within 24h
after admission, at least 2 symptoms of
pneumonia
Etizion 2007
[19]
Presumptive diagnosis of CAP based on
clinical presentation and
an infiltrate on chest radiographs
Hospitalised within 14 days, immunosuppression,
received parental antibiotics prior to blood culture,
aspiration pneumonitis, active treatment withdrawn
within 48
Not stated
Ewig 2004 [8]
New infiltrate together with symptoms
and signs of a lower respiratory tract
infection.
Bauer 2006
[16]
Hospital acquired pneumonia, immunosuppression,
pneumonia as a terminal event of disabling
comorbidity, alternative diagnosis during follow up
Severe immunosuppression, pneumonia expected as
terminal event of a chronic co-morbidity and
alternative diagnosis
Exclusions
and Followup
141 (4%)
patients
excluded due
to lack of
consent, or
missing data
84 (17%)
patients
excluded due
to missing data
179 (8%)
excluded due
to missing
outcome data
52 (3%)
patients had
incomplete
data
None
Outcome
ascertainment
Treatment Regimen
Patient interview
via telephone, and
medical records
review
Not mentioned
Not mentioned
79% were on betalactam & macrolide,
13% on beta-lactam
or macrolide alone
Not mentioned
52 (8%)
excluded due
to alternative
diagnosis
481 of 696
had datasets
for all risk
scores
Patient's charts
All had beta-lactam
with macrolide, or
levofloxacin,
or beta-lactam alone.
82% adhered to
Australian guidelines,
mainly beta-lactam
plus macrolide
Not mentioned
Not mentioned
Not mentioned
Independent party
checked data
validity and
consistency
Medical records of
readmitted patients
were independently
checked
Not mentioned
1
Gutierrez
2005 [20]
Age >=15 with signs and symptoms of
pneumonia, and radiological opacity
compatible with acute pneumonia
Patients hospitalized within 2 weeks were excluded
Huang 2008
[21]
Age >18 with clinical and radiological
diagnosis of pneumonia
Johnstone
2008 [22]
Age >17 with CAP with 2 or more
symptoms and radiographic evidence of
pneumonia
Age >18, new pulmonary infiltrates on
CXR, with at least one symptom
Transfers from other hospitals, recent pneumonia or
hospitalization,, chronic mechanical ventilation, cystic
fibrosis, active TB, HIV, alcoholism with end-organ
damage, palliative care, pregnancy
TB, cystic fibrosis, immunocompromised or pregnant
23 excluded
with
alternative
diagnosis
Not stated
Not mentioned
131 (4%) with
missing
outcomes
125 (8%) lost
to follow up
Not mentioned
All patients treated
according to standard
hospital guidelines
Not mentioned
Medical records
and interview
TB, bronchiectasis, haematological malignancy, HIV,
recent hospitalization, nursing home residents.
Pneumonia was expected terminal event, or distal to
bronchial obstruction.
Severe immunosuppression, pulmonary TB, recent
hospitalization, neutropaenia.
None
Checked against
Alberta Vittal
Statistics registry
Structured
interview of
patients or relatives
Not mentioned
Unclear
Not mentioned
Recent hospitalization, immunosuppresion,
leucopaenia, patients not for resuscitation
None
None
Not mentioned
None
Clinical features of acute infection and
new chest X-ray shadow
Infective exacerbation of COPD, aspiration pneumonia,
patients fed through gastrostomy
None
Pilotto 2009
[28]
Age >65, new infiltrate on chest X-ray
with compatible signs and symptoms
Patient with acute care hospitalization lasting 72 hours
or more within previous 15 days were excluded
26 lost to
follow-up
Renaud 2007
[29]
Age>18, acute onset with at least 2
symptoms or signs, and radiographic
HIV, cystic fibrosis, tracheotomy or chronic
mechanical ventilation, recent hospitalization
None
Checked against
computerized
patient database
Checked against
computerized
patient database
Direct patient
contact and
checking of death
certificates
Hospital records,
and telephone
Kruger 2008
[23]
Lim 2003 [5]
Hospital admission due to acute
respiratory illness with radiographic
shadowing on chest radiograph
Man 2007
[24]
Menendez
2009 [25]
Myint 2006
[26]
Age >17 with symptoms of acute
infection and infiltrate on chest
radiograph
New radiographic infiltrate with at least
two compatible clinical symptoms
Clinical features of acute infection and
new chest X-ray shadow
Myint 2009
[27]
Systemic immune deficiency, active TB or
hospitalisation less than four weeks prior to infection
77% received betalactam and/or
macrolide, 17% had
quinolone
Not mentioned
Not mentioned
Mainly beta-lactam
combined with
macrolide
Not mentioned
Not mentioned
Not mentioned
Unclear
2
evidence of pneumonia
Renaud-2
2007 [30]
Age>18, acute onset with at least 2
symptoms or signs, and radiographic
evidence of pneumonia
HIV, immunosuppression, recent hospitalization
46 (5%)
excluded with
alternative
diagnosis
Reyes
Calzada 2007
[31]
Schuetz 2008
[32]
van der
Eerden 2004
[33]
Age >18, symptoms of acute respiratory
infection, new infiltrate on CXR.,
None
110 excluded
Not mentioned
Not mentioned
Age >16, hospital admission due to
clinical and chest radiographic evidence
consistent with infection
43 (14%)
excluded with
alternative
diagnosis
18 lost to
follow-up
Information from
hospital records
and family doctor
Zuberi 2008
[35]
Immunocompromised patients (HIV, transplants,
immunosuppressive drugs), lung abscess, TB,
suspected aspiration, recent hospitalization, ITU patient
Cystic fibrosis, pulmonary TB, hospital-acquired
pneumonia and severe immunosuppression
Severe immunosuppression (HIV, immunosuppressive
drugs, chemotherapy), malignancy, pregnancy,
breastfeeding, allergy to antibiotics discharge, recent
hospitalization.
Post obstructive pneumonia, TB, bronchiectasis,
malignancy, HIV, immunocompromised patients and
nursing home residents, recent hospitalization
interviews of
patient, relatives or
family doctor
hospital records,
and telephone
interviews of
patient, relatives or
family doctor
Not mentioned
Last attended
clinical visit or
medical record
case file
Not mentioned
New infiltrate on chest radiograph with
one or more acute respiratory symptoms
Age >18, acute illness with symptoms of
pneumonia and new consolidation on
chest radiograph
41.3% initially
received antibiotics
as outpatient,
regimen unclear
Mainly beta-lactam
aand/or macrolide in
combination or alone
49% treated
3