title: Acute cough illness in general practice - predictive value of clinical judgement and accuracy of requesting chest x-rays.
abstract: The aim of the study was to evaluate the accuracy of GPs' initial clinical judgement regarding presence or absence of pneumonia and to assess GPs' strategy for requesting chest X-rays in patients presenting with acute cough. GPs were asked to rate their suspicion of pneumonia based on clinical assessment alone and to protocol their decision to perform chest X-rays in 212 consecutive patients. These judgements were compared to the final diagnosis as determined by chest X-ray or uneventful recovery (four weeks). After history taking and physical examination, GPs are highly accurate in judging which patients presenting with acute cough may have pneumonia (PPV 80% [95% CI 0,66-0,89]) or not (NPV 100% [95% CI 0,97-1,0]), and in which patients chest X-rays are required or not (spearman's rho 0,54, p<0,0001).
authors.affiliation: Institute of Primary Health Care Basel, University of Basel.
authors.forename: Silvana Romerio
authors.initials: SR
authors.lastname: Blaeuer
authors.forename: Klaus
authors.initials: K
authors.lastname: Bally
authors.forename: Peter
authors.initials: P
authors.lastname: Tschudi
authors.forename: Benedict
authors.initials: B
authors.lastname: Martina
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003371:Cough / Q000000981:diagnostic imaging* / Q000209:etiology*; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011014:Pneumonia / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D013557:Switzerland
keywords: Hausarztmedizin; Thorax Röntgenbild; akuter Husten; chest-X-ray; cough; decision making; examen physique; körperliche Untersuchung; médicine de famille; physical examination; primary health care; radiographie du thorax; toux aiguë