Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness.
OBJECTIVE
This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness.


METHODS
A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region.


RESULTS
Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age.


CONCLUSIONS
Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
Nolt
Brendon R
BR
The Center for Health Equity Research and Promotion, VA Medical Center and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
Gonzales
Ralph
R
Maselli
Judy
J
Aagaard
Eva
E
Camargo
Carlos A
CA
Metlay
Joshua P
JP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003371:Cough / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011674:Pulse; D012119:Respiration; D012680:Sensitivity and Specificity; D013610:Tachycardia / Q000209:etiology