Abstract
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°F (37.8°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°F explaining 30% of the variation. Rales, chest pain, and a temperature ≥ 100°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°F were the best predictors of a diagnosis of pneumonia.
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Evertsen, J., Baumgardner, D., Regnery, A. et al. Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices. Prim Care Respir J 19, 237–241 (2010). https://doi.org/10.4104/pcrj.2010.00024
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DOI: https://doi.org/10.4104/pcrj.2010.00024
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