title: Marked differences in GPs' diagnosis of pneumonia between Denmark and Spain: a cross-sectional study.
abstract: BACKGROUND
  In patients with lower respiratory tract infections (LRTIs) it is a challenge to identify who should be treated with antibiotics. According to international guidelines, antibiotics should be prescribed to patients with suspected pneumonia while acute bronchitis is considered a viral infection and should, generally, not be treated with antibiotics. Overdiagnosis of pneumonia in patients with LRTIs may lead to antibiotic overprescribing.
  
  
  OBJECTIVE
  To investigate the prevalence of presumed pneumonia in patients with LRTI in two countries with different antibiotic prescribing rates (Denmark and Spain) and to compare which symptoms and clinical tests are of most importance for the GP when choosing a diagnosis of pneumonia rather than acute bronchitis.
  
  
  METHODS
  A cross-sectional study including GPs from Denmark and Spain was conducted as part of the EU-funded project HAPPY AUDIT. A total of 2,698 patients with LRTI were included.
  
  
  RESULTS
  In Denmark, 47% of the patients with LRTI were classified with a diagnosis of pneumonia compared with 11% in Spain. In Spain, fever and a positive x-ray weighted significantly more in the diagnosis of pneumonia than in Denmark. Danish GPs, however, attached more importance to dyspnoea/polypnoea and C-reactive protein levels >50mg/L. None of the other typical symptoms of pneumonia had a significant influence.
  
  
  CONCLUSIONS
  Our results indicate that GPs' diagnostic criteria for pneumonia differ substantially between Denmark and Spain. The high prevalence of pneumonia among Danish patients with LRTI may indicate overdiagnosis of pneumonia which, in turn, may lead to antibiotic overprescribing.
authors.affiliation: Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Sarah Friis
authors.initials: SF
authors.lastname: Christensen
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Jørgensen
authors.forename: Gloria
authors.initials: G
authors.lastname: Cordoba
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.forename: Lars
authors.initials: L
authors.lastname: Bjerrum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001991:Bronchitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D058006:General Practice; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011859:Radiography; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein