Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Nazarian, Devorah J.; Eddy, Orin L.; Lukens, Thomas W.; Weingart, Scott D.; Decker, Wyatt W.

doi:10.1016/j.annemergmed.2009.07.002

Cited by 41 publications

(22 citation statements)

References 52 publications

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“…Detailed clinical history, routine laboratory tests (complete blood count and differential, glucose, serum electrolytes, liver- and renal-function tests), CRx, and CT scan, if indicated, contributed to confirm the diagnosis of CAP. Patients with other diagnoses or comorbidities potentially affecting chest imaging were excluded from the study [12]. Digital CRx images were obtained in a single posteroanterior view on upright patients (except two cases with Alzheimer disease who had only bedside portable CRx) and independently interpreted by a radiologist and an emergency physician, blind to chest US findings, with the determining support of a third physician, in case of conflicting results.…”

Section: Methodsmentioning

confidence: 99%

“…CRx was repeated if the clinical course justified a radiologic investigation to detect worsening of the illness or complications, but was not repeated before discharge in those with a satisfactory clinical recovery from pneumonia. Pretreatment samples of blood, sputum, and urine for microbiologic testing and urine antigen detection were collected from hospitalized patients with severe CAP and clinical indications [12]. Arterial blood gas analysis was obtained in the ED in patients with oximetry < 92%.…”

Section: Methodsmentioning

confidence: 99%

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Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Soldati²,

et al. 2012

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IntroductionThe clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.Methods98 patients who arrived in the Emergency Department complaining of influenza-like symptoms were enrolled in the study. Patients not displaying symptoms of acute respiratory distress were discharged without further investigations. Among patients with clinical suggestion of a community-acquired pneumonia, cases encountering other diagnoses or comorbidities were excluded from the study. Clinical history, laboratory tests, CRx, and computed tomography (CT) scan, if indicated, contributed to define the diagnosis of pneumonia in the remaining patients. Chest US was performed by an emergency physician, looking for presence of interstitial syndrome, alveolar consolidation, pleural line abnormalities, and pleural effusion, in 34 patients with a final diagnosis of pneumonia, in 16 having normal initial CRx, and in 33 without pneumonia, as controls.ResultsChest US was carried out without discomfort in all subjects, requiring a relatively short time (9 minutes; range, 7 to 13 minutes). An abnormal US pattern was detected in 32 of 34 patients with pneumonia (94.1%). A prevalent US pattern of interstitial syndrome was depicted in 15 of 16 patients with normal initial CRx, of whom 10 (62.5%) had a final diagnosis of viral (H1N1) pneumonia. Patients with pneumonia and abnormal initial CRx, of whom only four had a final diagnosis of viral (H1N1) pneumonia (22.2%; P < 0.05), mainly displayed an US pattern of alveolar consolidation. Finally, a positive US pattern of interstitial syndrome was found in five of 33 controls (15.1%). False negatives were found in two (5.9%) of 34 cases, and false positives, in five (15.1%) of 33 cases, with sensitivity of 94.1%, specificity of 84.8%, positive predictive value of 86.5%, and negative predictive value of 93.3%.ConclusionsBedside chest US represents an effective tool for diagnosing pneumonia in the Emergency Department. It can accurately provide early-stage detection of patients with (H1N1)v pneumonia having an initial normal CRx. Its routine integration into their clinical management is proposed.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Soldati²,

et al. 2012

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show abstract

“…The pressure for ED physicians to comply with the recommended quality measures may dwarf their concerns of the adverse effects of unnecessary antibiotic administration. 3,21,22 Currently, the focus has been on the process measures for pneumonia and not on achieving the correct diagnosis. 19 Respondents of another survey of ED physician leaders admitted ordering antibiotics for one third of the patients with suspected pneumonia before the chest radiographs are done, and half of them had implemented an automatic order for a chest radiograph at triage time.…”

Section: Discussionmentioning

confidence: 99%

Time to Antibiotics for Community-Acquired Pneumonia

Daas¹,

Sanchez²,

Khatib³

et al. 2012

Infectious Diseases in Clinical Practice

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“…They state that blood cultures are optional for hospitalized patients and should be performed in the presence of certain indications, such as admission to an intensive care unit, presence of cavitary infiltrates, leukopenia, active alcohol abuse, chronic severe liver disease, asplenia, or pleural effusion [5]. Guidelines from the American College of Emergency Physicians, American Academy of Family Physicians, the National Institute for Health, and Care Excellence and British Thoracic Society generally concur with these recommendations [6][7][8].…”

Section: Guidelinesmentioning

confidence: 95%

When practice and policy conflict: blood cultures in community-acquired pneumonia

Weerahandi

Poeran

Nassisi

et al. 2015

The American Journal of Emergency Medicine

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Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Cited by 41 publications

References 52 publications

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Time to Antibiotics for Community-Acquired Pneumonia

When practice and policy conflict: blood cultures in community-acquired pneumonia

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