Diagnosis of ambulatory community-acquired pneumonia. Comparison of clinical assessment versus chest X-ray.
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.
Lieberman
David
D
Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel. lieberma@bgumail.bgu.ac.il
Shvartzman
Pesach
P
Korsonsky
Igor
I
Lieberman
Devora
D
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