Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community

Macfarlane, John; Holmes, William F.; Gard, P; Macfarlane, R.M.; Rose, D H; Weston, Vivienne; Leinonen, Maija; Saikku, Pekka; Myint, S.

doi:10.1136/thorax.56.2.109

Cited by 288 publications

(265 citation statements)

References 21 publications

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“…Several primary care studies have assessed the diagnostic value of signs and symptoms as individual items or in combination for diagnosing pneumonia [4,5], but there is limited data on the accuracy of GPs' clinical judgment, independent of a formal diagnostic model in lower respiratory tract infection (LRTI). MACFARLANE et al [1] found that GPs could not identify the need for antibiotic treatment with sufficient precision in patients with LRTI who had microbiological evidence of a bacterial infection. MELBYE et al [5] compared GPs' clinical diagnosis of pneumonia with findings on chest radiographs and found that GPs made a clinical diagnosis of pneumonia in only a minority of the patients who had a radiographic diagnosis of pneumonia.…”

Section: Introductionmentioning

confidence: 99%

“…Most patients presenting with these symptoms in primary care are diagnosed as having acute bronchitis and a minority as having pneumonia. In general, pneumonia requires antibiotic treatment with close monitoring, while acute bronchitis is self-limiting and does not benefit meaningfully from antibiotic treatment [1][2][3]. General practitioners (GPs) usually have to either diagnose or exclude pneumonia on the basis of history, symptoms and signs alone, as it is neither feasible nor appropriate to perform chest radiographs in all patients presenting with acute cough or lower respiratory tract symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

et al. 2013

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Pneumonia is often diagnosed and treated empirically. We set out to determine the diagnostic accuracy of clinical judgment based on signs and symptoms to detect radiographic pneumonia in patients presenting with acute cough in primary care.In 2810 European patients with acute cough, general practitioners (GPs) recorded whether they considered pneumonia to be present (“yes” or “no”) immediately after history and physical examination. Chest radiography was performed within 1 week by local radiologists blind to other patient characteristics.140 patients had radiographic pneumonia (5%), of whom 41 (29%) had been diagnosed as such. 31 (1%) patients had a clinical diagnosis that was not confirmed by radiography (n=2670). In clinically suspected pneumonia, 57% of subjects were subsequently diagnosed with radiographic pneumonia. Negative predictive value (NPV), sensitivity and specificity of GPs’ clinical judgment were 96%, 29% and 99%, respectively. Compared to patients with a clinical diagnosis of pneumonia, less severe symptoms were found in radiographic pneumonia cases not suspected clinically (p<0.05).The predictive values of GPs’ clinical judgment, particularly the high NPVs, are helpful in routine care. Nonetheless, the majority of diagnoses of radiographic pneumonias was not suspected on clinical grounds. There is a need to further support the detection of clinically relevant pneumonia in primary care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

et al. 2013

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“…3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. [6][7][8][9] Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough.…”

Section: Introductionmentioning

confidence: 99%

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Vugt

Broekhuizen

Zuithoff

et al. 2012

The Annals of Family Medicine

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PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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“…2,3,4,5 International gibt es auffällig wenige Studien zu bakteriellen Erregern und deren Resistenzen, die aus einem allgemeinärztlichen Setting stammen. Dies mag teilweise damit erklärt werden, dass das Krankheitsbild im klinisch-stationären Bereich praktisch keine Relevanz hat und nur im Grenzbereich zur "community aquired pneumonia" -so z.B.…”

Section: Epidemiologie Der Erkrankung Und Der Erregerunclassified

12 Arzt-Patienten-Kommunikation

Kochen¹

2017

Allgemeinmedizin Und Familienmedizin

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Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community

Cited by 288 publications

References 21 publications

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

12 Arzt-Patienten-Kommunikation

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