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

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

Research output: Contribution to journalArticle

94 Citations (Scopus)

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 - 1989

Fingerprint

Hospital Emergency Service
Pneumonia
Thorax
Guidelines
Vital Signs
Respiratory Sounds
Percussion
Cough
Signs and Symptoms
Respiration
Fever
Lung
Temperature

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Clinical criteria for the detection of pneumonia in adults : Guidelines for ordering chest roentgenograms in the emergency department. / Gennis, Paul; Gallagher, E. John; Falvo, Cathey; Baker, Stephen; Than, William.

In: Journal of Emergency Medicine, Vol. 7, No. 3, 1989, p. 263-268.

Research output: Contribution to journalArticle

@article{6ad852dcacb04b17b309a6d1d6542f51,
title = "Clinical criteria for the detection of pneumonia in adults: Guidelines for ordering chest roentgenograms in the emergency department",
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.",
keywords = "auscultation, chest roentgenogram, pneumonia, respiratory illness, vital signs",
author = "Paul Gennis and Gallagher, {E. John} and Cathey Falvo and Stephen Baker and William Than",
year = "1989",
doi = "10.1016/0736-4679(89)90358-2",
language = "English (US)",
volume = "7",
pages = "263--268",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",
number = "3",

}

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, E. 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

UR - http://www.scopus.com/inward/record.url?scp=0024394581&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024394581&partnerID=8YFLogxK

U2 - 10.1016/0736-4679(89)90358-2

DO - 10.1016/0736-4679(89)90358-2

M3 - Article

C2 - 2745948

AN - SCOPUS:0024394581

VL - 7

SP - 263

EP - 268

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

IS - 3

ER -