Journal ArticleDOI
Clinical criteria for the detection of pneumonia in adults: Guidelines for ordering chest roentgenograms in the emergency department
TLDR
It is concluded that restricting chest roentgenograms to patients with at least one abnormal vital sign will detect almost all radiographically demonstrable pneumonia in adult emergency department patients.Abstract:
Adults presenting to an emergency department with acute respiratory illness were studied prospectively in an effort to identify sensitive clinical criteria for the diagnosis of pneumonia. Of 308 patients studied, 118 (38%) had definite or equivocal infiltrates and were considered to have pneumonia. No single symptom or sign was reliably predictive of pneumonia. Cough was the most common symptom in patients with pneumonia (86%), but was equally common in those with other respiratory illness. Fever was absent in 36 patients with pneumonia (31%). Abnormal findings on lung examination, that is, rales, rhonchi, decreased breath sounds, wheezes, altered fremitus, egophony, and percussion dullness, were each found in fewer than half of the patients with pneumonia. Twenty-six patients (22%) with a completely normal chest examination had pneumonia. Abnormal vital signs (temperature greater than 37.8 degrees C (100 degrees F), pulse greater than 100/min, or respirations greater than 20/min) were 97% sensitive for the detection of pneumonia. These criteria retained their sensitivity when films were subjected to a second, blinded interpretation by a senior radiologist. We conclude that restricting chest roentgenograms to patients with at least one abnormal vital sign will detect almost all radiographically demonstrable pneumonia in adult emergency department patients.read more
Citations
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Journal ArticleDOI
Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society
TL;DR: The Canadian CAP Working Group’s findings and recommendations will help improve the quality of care and reduce the number of adverse events in the care of severely ill patients.
Journal ArticleDOI
Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination.
TL;DR: Some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary.
Journal ArticleDOI
Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia
Joshua P. Metlay,Michael J. Fine +1 more
TL;DR: The clinician is faced with diagnostic and prognostic challenges in the initial management of patients with suspected community-acquired pneumonia, and the test characteristics of the history, physical examination, and laboratory findings in diagnosing community- Acquired pneumonia and predicting short-term risk for death from the infection are reviewed.
Journal Article
Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection.
Rogier M. Hopstaken,Jean W M Muris,J. A. Knottnerus,Arnold D. M. Kester,Paula E. L. M. Rinkens,Geert-Jan Dinant +5 more
TL;DR: Most symptoms and signs traditionally associated with pneumonia are not predictive of pneumonia in general practice, but a prediction rule for low-risk patients, including a CRP of < 20, can considerably reduce unjustified antibiotic prescribing.
Journal ArticleDOI
Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study.
S. F. van Vugt,Berna D L Broekhuizen,Christine Lammens,Nicolaas P.A. Zuithoff,P. A. de Jong,Samuel Coenen,Margareta Ieven,Christopher C Butler,Herman Goossens,Paul Little,Th J M Verheij +10 more
TL;DR: A clinical rule based on symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough performed best in patients with mild or severe clinical presentation.
References
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Journal ArticleDOI
Clinical Epidemiology: The Architecture of Clinical Research.
K. D. MacRae,Alvan R. Feinstein +1 more
TL;DR: Clinical Epidemiology: The Architecture of Clinical Research, by Alvan R. Feinstein.
Journal ArticleDOI
Prediction of pneumonia in outpatients with acute cough—A statistical approach
Paula Diehr,Paula Diehr,Robert W. Wood,Robert W. Wood,James B. Bushyhead,James B. Bushyhead,Leigh Krueger,Barry Wolcott,Barry Wolcott,Richard K. Tompkins,Richard K. Tompkins +10 more
TL;DR: The study results suggest that many pneumonias could be predicted based only on the patients histories, and physician visits to determine physical findings and chest X-rays might be avoided by telephone triage, with substantial cost savings.
Journal Article
The statistical assessment of the variability in observer perception and description of roentgenographic pulmonary shadows.
Journal ArticleDOI
Clinical Predictors of Pneumonia As a Guide to Ordering Chest Roentgenograms
TL;DR: To develop criteria for a more efficient approach to the ordering of chest roentgenograms, patients with fever or respiratory symptoms who were being evaluated with this diagnostic test were prospectively monitored.