Admission Chest Radiograph Lacks Sensitivity in the Diagnosis of Community-Acquired Pneumonia

Hagaman, Jared T.; Panos, Ralph J.; Rouan, Gregory W.; Shipley, Ralph

doi:10.1097/maj.0b013e31818ad805

Cited by 108 publications

(84 citation statements)

References 23 publications

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“…In H1N1 infl uenza infection, as in other types of community-acquired pneumonia ( 17 ), initial chest radiography may not show abnormalities that may develop later on in the course of the disease. Moreover, with pneumonia, similar to various other lung diseases, subtle lung opacities may be detected at chest CT when chest radiographs have normal results ( 10,18 ).…”

Section: Discussionmentioning

confidence: 93%

H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome

Aviram¹,

Bar-Shai²,

Sosna³

et al. 2010

Radiology

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Section: Discussionmentioning

confidence: 93%

H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome

Aviram¹,

Bar-Shai²,

Sosna³

et al. 2010

Radiology

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“…Practice varies over whether such individuals are included under the diagnosis of AECOPD, but most studies of prognosis in AECOPD requiring hospitalization have not excluded patients with complicating consolidation [6,7,10,11,22]. Furthermore, CT scanning in AECOPD often shows consolidation not visible by plain radiography [23,24] and the severity of airway obstruction and spectrum of pathogens in pneumonic and non-pneumonic exacerbations are similar [25]. Pneumonic AECOPD are not simply treated as pneumonia, but require specific management of the AECOPD, including controlled oxygen therapy, corticosteroids, nebulized bronchodilators and, if respiratory acidemia is present, noninvasive ventilation [26].…”

Section: Discussionmentioning

confidence: 97%

Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt

Nafae

Embarak

Gad

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are both common and often fatal. Lack of an accurate prognostic tool that can accurately predict inhospital mortality and help clinicians triaging patients to the appropriate level of care is a challenge. Toward this aim, the Dyspnea, Esinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) Score is needed to be assessed against other available scores.Patients and methods: Two hundred patients with primary diagnosis of AECOPD were included. They were subjected to thorough medical history taking, full clinical examination, plain chest X-ray, routine laboratory investigations, ECG, ABG s analysis, assessment of DECAF Score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, COPD and Asthma Physiology Score (CAPS) and CURB-65 score. Inhospital mortality was recorded.Results: Twenty-five (12.5%) patients died in hospital. The DECAF Score showed an excellent discrimination for inhospital mortality (AUROC = 0.83) and performed significantly better for the prediction of inhospital mortality than: APACHE II Score (AUROC = 0.68, DECAF vs APACHE II p = 0.03); and the COPD and Asthma Physiology Score (CAPS) (AUROC = 0.65, p = 0.01). Furthermore, DECAF was a significantly stronger predictor of inhospital mortality than CURB-65 for the subgroup of patients with radiological consolidation (AUROC = 0.87 vs 0.65, p = 0.02).Conclusion: The DECAF Score is a simple and effective clinical tool that can risk stratify hospitalized patients with AECOPD and could therefore help clinicians managing this fatal condition.

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“…At present, there is no sensitive and specific gold standard for associated viral or bacterial infection in patients with clinical pneumonia. The World Health Organization has proposed the use of radiographic endpoint pneumonia (pleural effusion or lobar consolidated infiltrates) to diagnose bacterial pneumonia in studies of the pneumococcal vaccine, despite the limited inter-and intrarater reliability of chest X-rays (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). This low to moderate reliability may preclude the use of chest X-ray as a gold standard in studies designed to discover biomarkers that will minimize the risk of overlooking bacterial infections when treating patients in a clinic.…”

Section: Discussionmentioning

confidence: 99%

“…Radiographic evidence of pneumonia has been used as an endpoint in studies of pneumococcal vaccine, but chest X-rays, particularly in resource-limited settings, have moderate reliability (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) and may result in both false positive and false negative diagnoses of bacterial pneumonia. Laboratory tests for viruses and bacteria have low sensitivity or specificity and are not readily available.…”

mentioning

confidence: 99%

Responses to Bacteria, Virus, and Malaria Distinguish the Etiology of Pediatric Clinical Pneumonia

Valim

Ahmad

Lanaspa

et al. 2016

Am J Respir Crit Care Med

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Rationale: Plasma-detectable biomarkers that rapidly and accurately diagnose bacterial infections in children with suspected pneumonia could reduce the morbidity of respiratory disease and decrease the unnecessary use of antibiotic therapy.Objectives: Using 56 markers measured in a multiplexed immunoassay, we sought to identify proteins and protein combinations that could discriminate bacterial from viral or malarial diagnoses. Methods:We selected 80 patients with clinically diagnosed pneumonia (as defined by the World Health Organization) who also met criteria for bacterial, viral, or malarial infection based on clinical, radiographic, and laboratory results. Ten healthy community control subjects were enrolled to assess marker reliability. Patients were subdivided into two sets: one for identifying potential markers and another for validating them.Measurements and Main Results: Three proteins (haptoglobin, tumor necrosis factor receptor 2 or IL-10, and tissue inhibitor of metalloproteinases 1) were identified that, when combined through a classification tree signature, accurately classified patients into bacterial, malarial, and viral etiologies and misclassified only one patient with bacterial pneumonia from the validation set. The overall sensitivity and specificity of this signature for the bacterial diagnosis were 96 and 86%, respectively. Alternative combinations of markers with comparable accuracy were selected by support vector machine and regression models and included haptoglobin, IL-10, and creatine kinase-MB.Conclusions: Combinations of plasma proteins accurately identified children with a respiratory syndrome who were likely to have bacterial infections and who would benefit from antibiotic therapy. When used in conjunction with malaria diagnostic tests, they may improve diagnostic specificity and simplify treatment decisions for clinicians.

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Admission Chest Radiograph Lacks Sensitivity in the Diagnosis of Community-Acquired Pneumonia

Cited by 108 publications

References 23 publications

H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome

H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome

Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt

Responses to Bacteria, Virus, and Malaria Distinguish the Etiology of Pediatric Clinical Pneumonia

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