TY - JOUR
T1 - Clinical criteria for the detection of pneumonia in adults
T2 - Guidelines for ordering chest roentgenograms in the emergency department
AU - Gennis, Paul
AU - Gallagher, John
AU - Falvo, Cathey
AU - Baker, Stephen
AU - Than, William
PY - 1989
Y1 - 1989
N2 - 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 > 37.8°C (100°F), pulse > 100/min, or respirations > 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.
AB - 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 > 37.8°C (100°F), pulse > 100/min, or respirations > 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.
KW - auscultation
KW - chest roentgenogram
KW - pneumonia
KW - respiratory illness
KW - vital signs
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U2 - 10.1016/0736-4679(89)90358-2
DO - 10.1016/0736-4679(89)90358-2
M3 - Article
C2 - 2745948
AN - SCOPUS:0024394581
SN - 0736-4679
VL - 7
SP - 263
EP - 268
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 3
ER -