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Systematic review and meta-analysis of the accuracy of clinical indicators for ineffective airway clearance




To report quantitative evidence for the accuracy of the defining characteristics of ineffective airway clearance in different settings and populations.


Defining characteristics are tests used by nurses to clinically indicate the presence or absence of a particular nursing diagnosis. A few studies have reported the accuracy of certain defining characteristics of ineffective airway clearance, but these studies address specific populations with particular needs.


A systematic review with meta-analysis was conducted to provide a synthesis and critical appraisal of the included studies.

Data sources

The electronic databases CINAHL, PubMed, Scopus and LILACS were searched using a systematic search strategy for studies published in any year. The last search was performed on 31 July 2013.

Review methods

Using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy and the Standards for Reporting of Diagnostic Accuracy (STARD), a systematic review was conducted using studies investigating the presence of ineffective airway clearance and its defining characteristics. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to evaluate the quality of the studies.


Seven papers met the search criteria. The studies were developed in different clinical settings and most of them fulfilled QUADAS criteria. Summary measures indicated the following defining characteristics with higher accuracy values: adventitious breath sounds, changes in respiratory rate, difficult vocalizing, diminished breath sounds, dyspnoea, ineffective cough, orthopnoea and restlessness.


This systematic review showed that the variability in clinical indicators of ineffective airway clearance is related to differences in the clinical settings and patients.