Clinical criteria for the detection of pneumonia in adults: Guidelines for ordering chest roentgenograms in the emergency department

Paul Gennis, John Gallagher, Cathey Falvo, Stephen Baker, William Than

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)263-268
Number of pages6
JournalJournal of Emergency Medicine
Volume7
Issue number3
DOIs
StatePublished - Jan 1 1989

Keywords

  • auscultation
  • chest roentgenogram
  • pneumonia
  • respiratory illness
  • vital signs

ASJC Scopus subject areas

  • Emergency Medicine

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