title: Suspected community-acquired pneumonia in an ambulatory setting (CAPA): a French prospective observational cohort study in general practice.
abstract: BACKGROUND
  Few studies have addressed the pragmatic management of ambulatory patients with suspected community-acquired pneumonia (CAP) using a precise description of the disease with or without chest X-ray (X-ray) evidence.
  
  
  OBJECTIVE
  To describe the characteristics, clinical findings, additional investigations and disease progression in patients with suspected CAP managed by French General Practitioners (GPs).
  
  
  METHODS
  The patients included were older than 18 years, with signs or symptoms suggestive of CAP associated with recent-onset unilateral crackles on auscultation or a new opacity on X-ray. They were followed for up to 6 weeks. Descriptive analyses of all patients and according to their management with X-rays were carried out.
  
  
  RESULTS
  From September 2011 to July 2012, 886 patients have been consulted by 267 GPs. Among them, 278 (31%) were older than 65 years and 337 (38%) were at increased risk for invasive pneumococcal disease. At presentation, the three most common symptoms, cough (94%), fever (93%), and weakness or myalgia (81%), were all observed in 70% of patients. Unilateral crackles were observed in 77% of patients. Among patients with positive radiography (64%), 36% had no unilateral crackles. A null CRB-65 score was obtained in 62% of patients. Most patients (94%) initially received antibiotics and experienced uncomplicated disease progression regardless of their management with X-rays. Finally, 7% of patients were hospitalised and 0.3% died.
  
  
  CONCLUSIONS
  Most patients consulting GPs for suspected CAP had the three following most common symptoms: cough, fever, and weakness or myalgia. More than a third of them were at increased risk for invasive pneumococcal disease. With or without X-rays, most patients received antibiotics and experienced uncomplicated disease progression.
authors.affiliation: Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Partouche
authors.affiliation: Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Buffel du Vaure
authors.affiliation: Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Personne
authors.affiliation: Service d'informatique médicale et de biostatistique, Hôpital Necker Enfants Malades, Paris, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Le Cossec
authors.affiliation: Service d'informatique médicale et de biostatistique, Hôpital Necker Enfants Malades, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Garcin
authors.affiliation: Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: 1] Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France [2] Collège National des Généralistes Enseignants (CNGE), France.
authors.forename: Christian
authors.initials: C
authors.lastname: Ghasarossian
authors.affiliation: Equipe d'accueil 24-15, Institut Universitaire de Recherche Clinique, Université Montpellier 1, Montpellier, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Landais
authors.affiliation: Inserm Umrs 1142 LIMICS, Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, UPMC, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Toubiana
authors.affiliation: Département de médecine générale, Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Gilberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005602:France; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000628:therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents