title: Clinical findings associated with radiographic pneumonia in nursing home residents.
abstract: OBJECTIVE
  Subtle presentation and the frequent lack of on-site physicians complicate the diagnosis of pneumonia in nursing home residents. We sought to identify clinical findings (signs, symptoms, and simple laboratory studies) associated with radiographic pneumonia in sick nursing home residents.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  The residents of 36 nursing homes in central Missouri and the St. Louis area with signs or symptoms suggesting a lower respiratory infection were included.
  
  
  METHODS
  We compared evaluation findings by project nurses with findings reported from chest radiographs.
  
  
  RESULTS
  Among 2334 episodes of illness in 1474 nursing home residents, 45% of the radiograph reports suggested pneumonia (possible=12%; probable or definite = 33%). In 80% of pneumonia episodes, subjects had 3 or fewer respiratory or general symptoms. Eight variables were significant independent predictors of pneumonia (increased pulse, respiratory rate =30, temperature =38 degrees C, somnolence or decreased alertness, presence of acute confusion, lung crackles on auscultation, absence of wheezes, and increased white blood count). A simple score (range = -1 to 8) on the basis of these variables identified 33% of subjects (score > or =3) with more than 50% probability of pneumonia and an additional 24% (score of 2) with 44% probability of pneumonia.
  
  
  CONCLUSIONS
  Pneumonia in nursing home residents is usually associated with few symptoms. Nonetheless, a simple clinical prediction rule can identify residents at very high risk of pneumonia. If validated in other studies, physicians could consider treating such residents without obtaining a chest radiograph.
authors.affiliation: Department of Family and Community Medicine, M228 Medical Sciences Bldg., University of Missouri-Columbia, Columbia, MO 65212, USA. MehrD@health.missouri.edu
authors.forename: D R
authors.initials: DR
authors.lastname: Mehr
authors.forename: E F
authors.initials: EF
authors.lastname: Binder
authors.forename: R L
authors.initials: RL
authors.lastname: Kruse
authors.forename: S C
authors.initials: SC
authors.lastname: Zweig
authors.forename: R W
authors.initials: RW
authors.lastname: Madsen
authors.forename: R B
authors.initials: RB
authors.lastname: D'Agostino
mesh_terms: D000203:Activities of Daily Living; D000465:Algorithms; D003663:Decision Trees; D016002:Discriminant Analysis; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008923:Missouri; D015999:Multivariate Analysis; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D009735:Nursing Homes; D018579:Patient Selection; D010808:Physical Examination / Q000379:methods* / Q000592:standards; D011014:Pneumonia / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index