Abstract
Introduction: It is still unclear what the best strategy to detect pneumonia in primary care patients should be.
Aim: To quantify the diagnostic value of history, physical examination and the added value of inflammation markers in detecting pneumonia in patients presenting with acute cough in primary care.
Methods: 2820 adult patients attending their general practioner with complaints of cough ≤28 days, were recruited from 12 European countries. Patient's history and physical examination were recorded on the day of presentation. C-reactive protein (CRP) and pro-calcitonin (PCT) were drawn from venous blood samples and chest radiographs were taken within the next three days. Pneumonia was diagnosed by chest X-ray. With multivariable logistic regression a diagnostic model was developed for diagnosing or ruling out pneumonia.
Results: 140 patients had radiographic pneumonia (5%). Symptoms and signs with independent diagnostic value were; absence of runny nose, presence of breathlessness, diminished vesicular breathing and crackles on auscultation, tachycardia (pulse >100/min), and temperature >37.8°C. Combined these items showed an area under the ROC curve of 0.70 (95% confidence interval 0.65-0.75). A combination of the 2 strongest predictors (crackles and temperature >37.8, n=30) had a positive predictive value for pneumonia of 37%. Analysis of the added value of CRP and PCT is in progress; results will be available in the presentation.
Conclusions: Radiographic pneumonia is uncommon in adults presenting in primary care with acute cough. Brief history and physical examination can help discriminate between those at high and low risk for pneumonia.
- © 2011 ERS