Abstract
Community-acquired pneumonia (CAP) is an essential consideration in patients presenting to primary care with respiratory symptoms; however, accurate diagnosis is difficult when clinical and radiological examinations are not possible, such as during telehealth consultations. To develop and test a smartphone-based algorithm for diagnosing CAP without need for clinical examination or radiological inputs. A prospective cohort study using data from participants aged >12 years presenting with acute respiratory symptoms to a hospital in Western Australia. Five cough audio-segments were recorded and four patient-reported symptoms (fever, acute cough, productive cough, and age) were analysed by the smartphone-based algorithm to generate an immediate diagnostic output for CAP. Independent cohorts were recruited to train and test the accuracy of the algorithm. Diagnostic agreement was calculated against the confirmed discharge diagnosis of CAP by specialist physicians. Specialist radiologists reported medical imaging. The smartphone-based algorithm had high percentage agreement (PA) with the clinical diagnosis of CAP in the total cohort (n = 322, positive PA [PPA] = 86.2%, negative PA [NPA] = 86.5%, area under the receiver operating characteristic curve [AUC] = 0.95); in participants 22-<65 years (n = 192, PPA = 85.7%, NPA = 87.0%, AUC = 0.94), and in participants aged ≥65 years (n = 86, PPA = 85.7%, NPA = 87.5%, AUC = 0.94). Agreement was preserved across CAP severity: 85.1% (n = 80/94) of participants with CRB-65 scores 1 or 2, and 87.7% (n = 57/65) with a score of 0, were correctly diagnosed by the algorithm. The algorithm provides rapid and accurate diagnosis of CAP. It offers improved accuracy over current protocols when clinical evaluation is difficult. It provides increased capabilities for primary and acute care, including telehealth services, required during the COVID-19 pandemic.
Highlights
Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality, an accurate diagnosis can be difficult and is reliant on excellent clinical skills with or without radiology
As current guidelines recommend moving towards digital consultations during the COVID-19 pandemic,[2] diagnosing CAP is even more challenging when doctors are unable to conduct clinical examinations
Pneumonia is the most common cause of infectious mortality, with >2 million adults dying from lower respiratory infections in 2015.3 CAP is an essential consideration in patients presenting with respiratory symptoms
Summary
CAP remains a leading cause of morbidity and mortality, an accurate diagnosis can be difficult and is reliant on excellent clinical skills with or without radiology. Diagnosis is more difficult in older people where symptoms and signs may be minimal, or where the presentation is modified by underlying comorbidities.[1] as current guidelines recommend moving towards digital consultations during the COVID-19 pandemic,[2] diagnosing CAP is even more challenging when doctors are unable to conduct clinical examinations. Pneumonia is the most common cause of infectious mortality, with >2 million adults dying from lower respiratory infections in 2015.3 CAP is an essential consideration in patients presenting with respiratory symptoms. Community-acquired pneumonia (CAP) is an essential consideration in patients presenting to primary care with respiratory symptoms; accurate diagnosis is difficult when clinical and radiological examinations are not possible, such as during telehealth consultations
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