Prediction of pneumonia in outpatients with acute cough—A statistical approach

Diehr, Paula; Wood, Robert; Bushyhead, James B.; Krueger, Leigh; Wolcott, Barry W.; Tompkins, Richard K.

doi:10.1016/0021-9681(84)90149-8

Cited by 167 publications

(134 citation statements)

References 3 publications

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“…Therefore, the high specificities and high LRs+ reported for some of these signs appear to be credible and to indicate that they may be useful in specific clinical contexts. For example, assuming that the pretest probability of pneumonia in outpatients with acute cough is 10% (odds 1:9) 38 , a finding of asymetric expansion of the chest would increase the odds to 8:9, i.e., increase the post-test probability to 47%. Assuming a pretest probability of pneumonia of 12-30% (odds 1:9-3:7) among emergency room patients with fever and acute respiratory symptoms 41 , a finding of pleural friction rub would increase the odds of pneumonia to 5:9-15:7 or to a posttest probability of 36-68%.…”

Section: Discussionmentioning

confidence: 99%

Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?

Benbassat

Baumal

2010

J GEN INTERN MED

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Section: Discussionmentioning

confidence: 99%

Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?

Benbassat

Baumal

2010

J GEN INTERN MED

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“…Previous trials have, however, showed no meaningful benefit from antibiotic treatment, on average, for patients consulting in primary care with acute cough and purulent sputum [ [32].…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Butler¹,

Kelly²,

Hood³

et al. 2011

European Respiratory Journal

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We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

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“…For example, Diehr et al [2] report that in 483 patients admitted to the emergency department (ED) complaining of cough, 2.6% have pneumonia, documented by radiogram.…”

Section: A Probabilistic Approach To Diagnosismentioning

confidence: 99%