Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices.
OBJECTIVE
To understand which clinical criteria physicians use to diagnose pneumonia compared to bronchitis and upper respiratory tract infection (URTI).


METHODS
Retrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.


RESULTS
Logistic regression analysis identified rales, a temperature > 100 degrees F (37.8 degrees C), chest pain, dyspnoea, rhonchi, heart rate, respiratory rate, and rhinorrhoea, as the best explanation for the variation in diagnosis of pneumonia compared to either of the alternative diagnoses (R2 = 59.3), with rales and a temperature > 100 degrees F explaining 30% of the variation. Rales, chest pain, and a temperature > 100 degrees F best predicted the ordering of a chest x-ray (R2 = 20.0). However, 35% (59/175) of patients diagnosed with pneumonia had a negative chest x-ray. Abnormal breath sounds were the best predictors for prescribing antibiotics (R2 = 38%). A significant number of patients with acute bronchitis (93% excluding sinusitis) and URTI (42%) were given antibiotics.


CONCLUSIONS
The presence of abnormal breath sounds and a temperature > 100 degrees F were the best predictors of a diagnosis of pneumonia.
Evertsen
Jennifer
J
University of Wisconsin School of Medicine and Public Health, Milwaukee, WI 53233, USA. evertsen@wisc.edu
Baumgardner
Dennis J
DJ
Regnery
Ann
A
Banerjee
Indrani
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000175:diagnosis* / Q000628:therapy; D002637:Chest Pain / Q000175:diagnosis; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D056152:Respiratory Rate; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D014922:Wisconsin; D055815:Young Adult
D000900:Anti-Bacterial Agents