title: Diagnosis of ambulatory community-acquired pneumonia. Comparison of clinical assessment versus chest X-ray.
abstract: OBJECTIVE
  When evaluating patients with respiratory tract infections (RTI), physicians have to judge and decide whether the patient has pneumonia or not. This decision is usually made by clinical assessment alone and/or by performing a chest X-ray. The aim of this study was to determine the reliability of physicians' judgements relating to the presence of pneumonia in RTI patients by clinical assessment alone compared with chest X-ray.
  
  
  METHODS
  A prospective, clinical study.
  
  
  METHODS
  Primary care clinics and a university hospital in southern Israel.
  
  
  METHODS
  Two-hundred-and-fifty ambulatory patients with febrile RTI were included in a prospective study. On the basis of a medical interview and physical examination alone physicians were asked to make judgements relating to the study question, and these judgements were compared with the results of chest X-rays.
  
  
  RESULTS
  Physicians' judgements of pneumonia had a sensitivity of 74% (49-90%), a specificity of 84% (78-88%), a negative predictive value of 97% (94-99%) and a positive predictive value of only 27% (16-42%), compared to the results of chest X-ray.
  
  
  CONCLUSIONS
  We conclude that the ability of physicians to negate X-ray confirmed pneumonia by clinical assessment in febrile adult RTI patients is good, but that their ability to successfully predict this condition is poor.
authors.affiliation: Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel. lieberma@bgumail.bgu.ac.il
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
authors.forename: Igor
authors.initials: I
authors.lastname: Korsonsky
authors.forename: Devora
authors.initials: D
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity