Heckerling's Criteria to Distinguish Community-Acquired Pneumonia in Primary Care Settings: Observational Validation Study in Japan.

Background: Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. Chest radiography is the standard means of confirmation of pneumonia, but patients may be unnecessarily exposed to radiation. Heckerling's criteria (HC) scoring is a useful substitute for chest radiography and can be used to rule out CAP. HC score ≥ 4 is strongly indicative of pneumonia, while ≤ 1 indicates the patient is pneumonia-free. HC scoring is well validated in Western populations, but has not been validated in an Asian population. Racial differences in symptoms and differences in the method of measuring body temperature may affect the validity of HC scoring in this population. We evaluate the use of HC scoring in a Japanese primary care setting. Methods: We conducted a prospective observational study of febrile patients aged ≥ 16 years that had respiratory symptoms in either of two community hospitals between December 2016 and October 2018. We evaluated the accuracy of HC in discrimination of patients with and without CAP. Pneumonia was defined as respiratory symptoms with new infiltration recognized on chest X-ray or chest computed tomography. Results: Analyzable data from 296 of 341 patients was available (37.2% were female, mean age: 41.1 years). CAP was diagnosed in 58 patients (19.6%). HC discriminated CAP with ROC area of 0.69 (95% CI 0.62-0.76). Sensitivity was 0.66 (95% CI 0.52-0.78) (HC score ≤ 1) and specificity was 0.68 (95% CI 0.61-0.74) (HC score > 1). Conclusions: HC did not detect CAP in approximately 30% of our Japanese cases of acute respiratory illness. HC scoring should be used cautiously in non-Western populations. [ABSTRACT FROM AUTHOR]