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Predictors of pneumonia in lower respiratory tract infections: 3C prospective Cough Complication Cohort study

Predictors of pneumonia in lower respiratory tract infections: 3C prospective Cough Complication Cohort study
Predictors of pneumonia in lower respiratory tract infections: 3C prospective Cough Complication Cohort study

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.

A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

0903-1936
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Smith, Sue
6679a4a5-f362-435f-a533-5e8e73c2af1f
Thompson, Matthew J.
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Knox, Kyle
e3415c23-e33b-43e1-8791-2ce1f4d11aae
van den Bruel, Ann
bd3225c7-17d2-48f2-adfe-11d3dd337522
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Mant, David
b663daa9-785a-4b0b-ad20-7583d0fe75b7
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Smith, Sue
6679a4a5-f362-435f-a533-5e8e73c2af1f
Thompson, Matthew J.
a727ec80-d889-419d-b017-eb07897972fe
Knox, Kyle
e3415c23-e33b-43e1-8791-2ce1f4d11aae
van den Bruel, Ann
bd3225c7-17d2-48f2-adfe-11d3dd337522
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Mant, David
b663daa9-785a-4b0b-ad20-7583d0fe75b7

Moore, Michael, Stuart, Beth, Little, Paul, Smith, Sue, Thompson, Matthew J., Knox, Kyle, van den Bruel, Ann, Lown, Mark and Mant, David (2017) Predictors of pneumonia in lower respiratory tract infections: 3C prospective Cough Complication Cohort study. European Respiratory Journal, 50 (5), [1700434]. (doi:10.1183/13993003.00434-2017).

Record type: Article

Abstract

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.

A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

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Accepted/In Press date: 16 August 2017
e-pub ahead of print date: 22 November 2017
Published date: 22 November 2017

Identifiers

Local EPrints ID: 413373
URI: http://eprints.soton.ac.uk/id/eprint/413373
ISSN: 0903-1936
PURE UUID: c5c621af-106a-4b20-9fbb-854c4612b3b0
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873
ORCID for Mark Lown: ORCID iD orcid.org/0000-0001-8309-568X

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Date deposited: 23 Aug 2017 16:31
Last modified: 12 Jul 2024 04:07

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Contributors

Author: Michael Moore ORCID iD
Author: Beth Stuart ORCID iD
Author: Paul Little ORCID iD
Author: Sue Smith
Author: Matthew J. Thompson
Author: Kyle Knox
Author: Ann van den Bruel
Author: Mark Lown ORCID iD
Author: David Mant

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