Primary care respiratory journal : journal of the General Practice Airways Group · 2010
Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices.
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Evertsen Jennifer, Baumgardner Dennis J, Regnery Ann, Banerjee Indrani
Аннотация
AIMS: To understand which clinical criteria physicians use to diagnose pneumonia compared to bronchitis and upper respiratory tract infection (URTI).
METHODS: Retrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.
RESULTS: Logistic regression analysis identified rales, a temperature > 100 degrees F (37.8 degrees C), chest pain, dyspnoea, rhonchi, heart rate, respiratory rate, and rhinorrhoea, as the best explanation for the variation in diagnosis of pneumonia compared to either of the alternative diagnoses (R2 = 59.3), with rales and a temperature > 100 degrees F explaining 30% of the variation. Rales, chest pain, and a temperature > 100 degrees F best predicted the ordering of a chest x-ray (R2 = 20.0). However, 35% (59/175) of patients diagnosed with pneumonia had a negative chest x-ray. Abnormal breath sounds were the best predictors for prescribing antibiotics (R2 = 38%). A significant number of patients with acute bronchitis (93% excluding sinusitis) and URTI (42%) were given antibiotics.
CONCLUSIONS: The presence of abnormal breath sounds and a temperature > 100 degrees F were the best predictors of a diagnosis of pneumonia.
METHODS: Retrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.
RESULTS: Logistic regression analysis identified rales, a temperature > 100 degrees F (37.8 degrees C), chest pain, dyspnoea, rhonchi, heart rate, respiratory rate, and rhinorrhoea, as the best explanation for the variation in diagnosis of pneumonia compared to either of the alternative diagnoses (R2 = 59.3), with rales and a temperature > 100 degrees F explaining 30% of the variation. Rales, chest pain, and a temperature > 100 degrees F best predicted the ordering of a chest x-ray (R2 = 20.0). However, 35% (59/175) of patients diagnosed with pneumonia had a negative chest x-ray. Abnormal breath sounds were the best predictors for prescribing antibiotics (R2 = 38%). A significant number of patients with acute bronchitis (93% excluding sinusitis) and URTI (42%) were given antibiotics.
CONCLUSIONS: The presence of abnormal breath sounds and a temperature > 100 degrees F were the best predictors of a diagnosis of pneumonia.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsBronchitisChest PainConfidence IntervalsDiagnosis, DifferentialDyspneaFemaleFeverHeart RateHumansLogistic ModelsMaleMiddle AgedOdds RatioPneumoniaPractice Patterns, Physicians'Primary Health CareRadiography, ThoracicRespiratory RateRespiratory Tract InfectionsRetrospective StudiesWisconsinYoung Adult