Patterns of Resolution of Chest Radiograph Abnormalities in Adults Hospitalized with Severe Community-Acquired Pneumonia

Abstract

Background. Timing of follow-up chest radiographs for patients with severe community-acquired pneumonia (CAP) is difficult, because little is known about the time to resolution of chest radiograph abnormalities and its correlation with clinical findings. To provide recommendations for short-term, in-hospital chest radiograph followup, we studied the rate of resolution of chest radiograph abnormalities in relation to clinical cure, evaluated predictors for delayed resolution, and determined the influence of deterioration of radiographic findings during follow-up on prognosis.Methods. A total of 288 patients who were hospitalized because of severe CAP were followed up for 28 days in a prospective multicenter study. Clinical data and scores for clinical improvement at day 7 and clinical cure at day 28 were obtained. Chest radiographs were obtained at hospital admission and at days 7 and 28. Resolution and deterioration of chest radiograph findings were determined.Results. At day 7, 57 (25%) of the patients had resolution of chest radiograph abnormalities, whereas 127 (56%) had clinical improvement (mean difference, 31%; 95% confidence interval, 25%-37%). At day 28, 103 (53%) of the patients had resolution of chest radiograph abnormalities, and 152 (78%) had clinical cure (mean difference, 25%; 95% confidence interval, 19%-31%). Delayed resolution of radiograph abnormalities was independently associated with multilobar disease (odds ratio, 2.87; ); dullness to percussion at physical ex-P р .01 amination (odds ratio, 6.94;); high C-reactive protein level, defined as 1200 mg/L (odds ratio, 4.24; P р .01 ); and high respiratory rate at admission, defined as 125 breaths/min (odds ratio, 2.42;). There P р .001 P р .03 were no significant differences in outcome at day 28 between patients with and patients without deterioration of chest radiograph findings during the follow-up period ( ). P 1 .09 Conclusions. Routine short-term follow-up chest radiographs (obtained !28 days after hospital admission) of hospitalized patients with severe CAP seem to provide no additional clinical value.

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

“…24,25 However, clinical cure does not reflect patients' perspectives of recovery and, in reality, patientreported symptomatic resolution lags significantly behind physician-rated clinical cure. 1,5,26 The frequency of healthcare reconsultation reported in this study is higher than expected, given the low disease severity and comorbidity of the study population of working-age adults. The principal reason for further healthcare utilisation in these adults was persistence of respiratory symptoms, and mainly occurred at the primary care level within 2 weeks of hospital discharge.…”

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

“…19,21 And there is a relationship between delayed resolution of pneumonia and the extent of the alveolar involvement on chest radiograph. 22 COPD is not a determinant of higher pneumonia severity in the Pneumonia Severity Index or CURB-65 systems, but in clinical practice COPD is a factor in hospital admission in patients who are initially classified as having mild pneumonia. 23,24 In patients with severe pneumonia, COPD is associated with an unfavorable clinical course, more complications, ICU admission, mechanical ventilation, and higher mortality than in those without COPD.…”

Community acquired pneumonia: assessment and treatment

“…It should be noted that radiographic evidence of resolution lags behind clinical resolution. 14,15 The problem in patients who fail to respond to initial antimicrobial therapy may be a resistant or unsuspected pathogen, inadequate dosing or absorption of medication, or misdiagnosis. Hospital discharge should not be considered if a patient has any of the following: temperature above 37.8°C, heart rate over 100 bpm, respiratory rate above 24 bpm, systolic BP below 90 mmHg, saturations below 90% on air, altered cognition or is unable to tolerate oral intake.…”