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.
Moore, Michael
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Stuart, Beth
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Little, Paul
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Smith, Sue
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Thompson, Matthew J.
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Knox, Kyle
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van den Bruel, Ann
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Lown, Mark
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Mant, David
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22 November 2017
Moore, Michael
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Stuart, Beth
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Little, Paul
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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
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Mant, David
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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).
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
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Local EPrints ID: 413373
URI: http://eprints.soton.ac.uk/id/eprint/413373
ISSN: 0903-1936
PURE UUID: c5c621af-106a-4b20-9fbb-854c4612b3b0
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Date deposited: 23 Aug 2017 16:31
Last modified: 16 Mar 2024 05:39
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Author:
Sue Smith
Author:
Matthew J. Thompson
Author:
Kyle Knox
Author:
Ann van den Bruel
Author:
David Mant
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