A 9-month old infant has been admitted with fever, cough, shortness of breath and poor feeding. He is tachypnoeic with bilateral crackles and occasional rhonchi. Initial management is started with a provisional diagnosis of bronchiolitis. Nasopharyngeal aspirate for respiratory syncytial virus turns out to be negative. Over the next few hours, he is noted to have high grade pyrexia with a gradual clinical deterioration. As the on-call specialist registrar in paediatrics, you are now worried about a possible bacterial aetiology. You decide to commence antibiotics after sending a sample for blood culture. A chest radiograph, full blood count and C-reactive protein level do not help to distinguish between a viral versus bacterial infection. You are aware that in an infant with bacterial pneumonia, the most common causative organism is Streptococcus pneumoniae. A colleague informs you that your hospital laboratory can perform a rapid immunochromatographic urine antigen detection test which is widely used for diagnosing pneumococcal infections in adults.

You are not sure about the diagnostic utility of this test in children. You decide to do a literature search and critically appraise the evidence.

STRUCTURED CLINICAL QUESTION

In a child with possible pneumococcal infection [subject], is immunochromatographic rapid urine antigen testing [intervention] a reliable screening test to diagnose/exclude pneumococcal aetiology [outcome]?

SEARCH STRATEGY AND OUTCOME

Secondary sources

Cochrane Library, Best Evidence, Clinical Evidence: no relevant articles found.

Primary sources

Medline (1966 to date) and OLDMEDLINE (1950–1965) searched by the PubMed interface on 31 December 2007.

“Pneumococcal antigen urine” with limits (English, Human, All Child: 0–18 years) yielded 72 results. Replacement of “pneumococcal” with “pneumococcus” did not broaden the search. Among the results, there were no systematic reviews relevant to the clinical question.

Studies on purely adult populations as …