PURPOSE: This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. METHODS: A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. RESULTS: Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. CONCLUSIONS: Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
PURPOSE: This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. METHODS: A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. RESULTS: Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. CONCLUSIONS: Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
Authors: Michael Moore; Beth Stuart; Paul Little; Sue Smith; Matthew J Thompson; Kyle Knox; Anne van den Bruel; Mark Lown; David Mant Journal: Eur Respir J Date: 2017-11-22 Impact factor: 16.671
Authors: Saskia F van Vugt; Berna D L Broekhuizen; Christine Lammens; Nicolaas P A Zuithoff; Pim A de Jong; Samuel Coenen; Margareta Ieven; Chris C Butler; Herman Goossens; Paul Little; Theo J M Verheij Journal: BMJ Date: 2013-04-30
Authors: Sylvain DeLisle; Bernard Kim; Janaki Deepak; Tariq Siddiqui; Adi Gundlapalli; Matthew Samore; Leonard D'Avolio Journal: PLoS One Date: 2013-08-13 Impact factor: 3.240