title: Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia.
abstract: BACKGROUND
  Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia.
  
  
  OBJECTIVE
  This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP).
  
  
  METHODS
  A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared.
  
  
  RESULTS
  The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%).
  
  
  CONCLUSIONS
  This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood of morbidity if CAP is not initially detected.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Ebrahimzadeh
authors.affiliation: Department of Radiology, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Mahyar
authors.initials: M
authors.lastname: Mohammadifard
authors.affiliation: Department of Surgery, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Godratallah
authors.initials: G
authors.lastname: Naseh
authors.affiliation: Department of Radiology, Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirgholami
keywords: Acute Chest Syndrome; Mass Chest X-Ray; Pneumonia; Prediction Rule