Abstract
Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has significant drawbacks. We used a cohort of 200 consecutive elderly patients admitted to the hospital for suspected pneumonia to build a simple prediction score, which was used to determine indication for performing a CT-scan. The reference diagnosis was adjudicated by experts considering all available data, including evolution until discharge and CT scan in all patients. Results were externally validated in a second cohort of 319 patients. Pneumonia was confirmed in 133 patients (67%). Area under the receiver operator curve (AUROC) of physician evaluation was 0.55 (0.46–0.64). The score incorporated four variables independently predicting confirmed pneumonia: male gender, acute cough, C-reactive protein >70 mg/L, and urea <7 mmol/L. AUROC of the score was 0.68 (95% confidence interval (CI) 0.60–0.76). When a CT-scan was obtained for patients at low or intermediate predicted risk (108 patients, 54% of the cohort), AUROC was 0.71 (0.63–0.80) and 0.69 (0.64–0.74) in the derivation and validation cohort, respectively. A simple prediction score for pneumonia had moderate accuracy and could guide the performance of a CT-scan.
Highlights
We explored the univariate association of data obtained during standard evaluation of patients with the presence of pneumonia according to the reference standard
We evaluated the accuracy of the algorithm in a second cohort composed of 319 adult patients visiting the emergency department of four French tertiary hospitals for suspected pneumonia who all had a computed tomography scan lacks (CT-scan) performed [5]
A clinical prediction score based on four available variables allows for more superior accuracy for the diagnosis of pneumonia than standard assessment
Summary
Diagnosing pneumonia is a major challenge in emergency departments and ambulatoryAccurately diagnosing pneumonia major challenge emergency departments and(CXR)ambulatory settings.The current reference diagnosisisisathe presence of aninacute infiltrate on chest X-ray along settings.diagnosis is the presencesymptoms of an acuteand infiltrate X-ray (CXR)along with consistent symptoms and signs [1].signs on of chest pneumonia are neither with consistent symptoms and signsin[1].theHowever, symptoms signs of pneumonia neither sensitive nor specific, elderly [2,3].As a and confirmation test, CXR are lacks both sensitive norand specific, the elderly [2,3].As a confirmation test, CXR both sensitivity sensitivity specificity when in compared with computed tomography scan lacks (CT-scan)[4,5], and and specificity agreement when compared computed tomography scan[6]. Diagnosing pneumonia is a major challenge in emergency departments and ambulatory. Diagnosing pneumonia major challenge emergency departments and(CXR). The current reference diagnosisisisathe presence of aninacute infiltrate on chest X-ray along settings. Diagnosis is the presencesymptoms of an acuteand infiltrate X-ray (CXR). Signs on of chest pneumonia are neither with consistent symptoms and signsin[1].theHowever, symptoms signs of pneumonia neither sensitive nor specific, elderly [2,3]. As a and confirmation test, CXR are lacks both sensitive norand specific, the elderly [2,3]. CXR both sensitivity sensitivity specificity when in compared with computed tomography scan lacks (CT-scan). [4,5], and and specificity agreement when compared computed tomography scan[6]
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