Pneumonia recovery: discrepancies in perspectives of the radiologist, physician and patient.
BACKGROUND
Chest radiographs are often used to diagnose community-acquired pneumonia (CAP), to monitor response to treatment and to ensure complete resolution of pneumonia. However, radiological exams may not reflect the actual clinical condition of the patient.


OBJECTIVE
To compare the radiographic resolution of mild to moderately severe CAP to resolution of clinical symptoms as assessed by the physician or rated by the patient.


METHODS
Prospective cohort study.


METHODS
One hundred nineteen patients admitted because of mild to moderately severe CAP with new pulmonary opacities.


METHODS
Radiographic resolution and clinical cure of CAP were determined at day 10 and 28. Radiographic resolution was defined as the absence of infection-related abnormalities; clinical cure was rated by the physician and defined by improvement of signs and symptoms. In addition, the CAP score, a patient-based symptom score, was calculated.


RESULTS
Radiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3-16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure.


CONCLUSIONS
In mild to moderately severe CAP, resolution of radiographic abnormalities and resolution of symptoms scored by the patient lag behind clinical cure assessed by physicians. Monitoring a favorable disease process by routine follow-up chest radiographs seems to have no additional value above following a patient's clinical course.
Bruns
Anke H W
AH
Division of Medicine, Department of Internal Medicine and Infectious Diseases, University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands. A.H.W.Bruns@umcutrecht.nl
Oosterheert
Jan Jelrik
JJ
El Moussaoui
Rachida
R
Opmeer
Brent C
BC
Hoepelman
Andy I M
AI
Prins
Jan M
JM
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000534:rehabilitation; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D011446:Prospective Studies; D011859:Radiography; D011871:Radiology; D020127:Recovery of Function / Q000502:physiology