William Terrence O'Brien DO, Presenter: Nothing to Disclose

Grant Edward Lattin MD, Abstract Co-Author: Nothing to Disclose

Matthew Duncan MD, Abstract Co-Author: Nothing to Disclose

To develop a prediction rule for the use of chest radiographs in evaluating for community-acquired pneumonia based upon presenting signs and symptoms.

Adult patients with acute respiratory symptoms and positive chest radiographs from October 2004 through April 2005 were enrolled as positive cases (n=350). An equal number of age-matched controls with acute respiratory symptoms but negative radiographs were included. Data analyses were performed on the six most common individual clinical indicators (cough, sputum production, fever, tachycardia, tachypnea, and abnormal physical examination). Additional analyses were performed for any vital sign abnormality, and for the presence of vital sign or physical examination abnormalities.

Our data show that vital sign and physical examination findings are useful screening parameters for community-acquired pneumonia, demonstrating a sensitivity of 95%, a specificity of 56%, and an odds ratio of 24.9 in the presence of vital sign or physical examination abnormalities. In light of these results, we developed a prediction rule for low-risk patients with reliable follow-up, which states that chest radiographs are unnecessary in the presence of normal vital signs and physical examination findings.

Our data suggest that chest radiographs are unnecessary in patients with acute respiratory symptoms that present with normal vital signs and physical examination findings. Since approximately 5% of cases would be missed, however, these criteria are only useful for patients with reliable follow-up and a low likelihood of morbidity if community-acquired pneumonia is not detected initially.

Our prediction rule suggests that chest radiographs are unnecessary in patients with acute respiratory symptoms that present with normal physical examination findings and vital signs.

O'Brien, W, Lattin, G, Duncan, M, Clinical Indicators of Radiographic Findings in Patients with Suspected Community-acquired Pneumonia: Who Needs a Chest X-ray?.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4426316.html