Diagnosing Pneumonia by Physical Examination

Wipf, Joyce E.; Lipsky, Benjamin A.; Hirschmann, Jan V.; Boyko, Edward J.; Takasugi, Julie E.; Peugeot, Reneé L.; Davis, Connie L.

doi:10.1001/archinte.159.10.1082

Cited by 240 publications

(127 citation statements)

References 14 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…In humans, a French study performed in a hospital setting with better auscultation conditions than on a farm, the performance of thoracic auscultation was poor for detection of alveolar consolidation (sensitivity = 36%) 26. The available evidence concerning the use of lung sounds in a clinical setting is a recurrent debate in the human medical literature 27, 28…”

Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Buczinski

Forte

Francoz

et al. 2013

Veterinary Internal Medicne

131

150

View full text Add to dashboard Cite

BackgroundThe diagnostic tools for bovine respiratory disease diagnosis include clinical inspection, thoracic auscultation, and ultrasonography.HypothesisThoracic auscultation and clinical examination have limitations in the detection of lung consolidation in dairy calves.AnimalsProspective cohort of 106 preweaned calves from 13 different dairy herds (10 with a history of active bovine respiratory disease (BRD) in calves and 3 without suspected BRD problems).MethodsEach preweaned calf was clinically inspected using the Wisconsin calf respiratory scoring chart (CRSC) and treatment history was noted. Systematic thoracic auscultation and ultrasonography then were performed, the latter focusing on lung consolidation. Mortality was recorded over a 30‐day period.ResultsA total of 56 of 106 calves had ultrasonographic evidence of lung consolidation. The sensitivity of thoracic auscultation to detect consolidation was 5.9% (range, 0–16.7%). Only 41.1% (23/33) of calves with consolidated lungs had been treated previously by the producers. When adding CRSC and previous BRD treatment by the producer, sensitivity of detection increased to 71.4% (40/56). The area under the receiver operating characteristics curve was 0.809 (95% CI, 0.721–0.879) for the number of areas within the lungs with consolidation and 0.743 (95% CI, 0.648–0.823) for the maximal depth of consolidation as predictors of death within 1 month after examination. These were not significantly different (P = .06).Conclusions and Clinical ImportanceThis study shows that thoracic auscultation is of limited value in diagnosing lung consolidation in calves. Ultrasonographic assessment of the thorax could be a useful tool to assess BRD detection efficiency on dairy farms.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Buczinski

Forte

Francoz

et al. 2013

Veterinary Internal Medicne

131

150

View full text Add to dashboard Cite

show abstract

“…9 Wipf et al searched the utility of physical chest findings and inter-rater reliability in patients suspected of having pneumonia, the sensitivity of physical examination to diagnose pneumonia was 47% to 69%, with a specificity of 58% to 75%. 16 They concluded that the most valuable signs in detecting pneumonia were unilateral rales and the traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia. 16 A febrile transplant patient with signs and symptoms of pneumonia but a negative chest radiograph or a patient with a radiograph suggestive of a new mass lesion, CT scan of the thorax may be indicated in the ED.…”

Section: Discussionmentioning

confidence: 99%

“…16 They concluded that the most valuable signs in detecting pneumonia were unilateral rales and the traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia. 16 A febrile transplant patient with signs and symptoms of pneumonia but a negative chest radiograph or a patient with a radiograph suggestive of a new mass lesion, CT scan of the thorax may be indicated in the ED. In our study, patient X was a 35-year-old woman who presented to the ED with chest pain, cough and sputum.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings

Bektaş¹,

Söyüncü²,

Yiğit³

et al. 2012

Turkiye Klinikleri J Med Sci

View full text Add to dashboard Cite

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of the study is to determine the diagnostic accuracy of emergency physician judgment for diagnosis of pneumonia in transplant patients with fever in emergency settings. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This prospective, convenience sample study was performed in a tertiary care university emergency department. All solid organ transplant patients presenting to the emergency department with fever as a chief complaint, between 08:00 and 24:00 hours were enrolled into the study. Before performing chest X-ray, according to the clinical findings of pneumonia, emergency physician need to assign a pre-chest X-ray level of certainty for pneumonia using a visual analog scale from 0 mm to 100 mm, with 100 mm being the most certain. The chest X-ray reports were classified into three groups: Normal, pneumonia (having pulmonary infiltrates diagnostic and suggestive of pneumonia) and abnormal but not pneumonia. R Re es su ul lt ts s: : Of the 77 study patients, 10 (13%) patients were diagnosed as pneumonia. Sensitivity, specificity and positive and negative likelihood ratio of the judgment of emergency physician in diagnosing pneumonia in our patients population were 70% [95% confidence interval (CI): 35-91], 94% (95% CI: 84-98), 11.7 (95% CI: 4.1-32.9) and 0.31 (95% CI: 0.12-0.82), respectively. C Co on nc cl lu us si io on n: : In the presence of clinical signs of pneumonia, diagnostic accuracy of emergency physician judgment was high for diagnosis of pneumonia in transplant patients with fever in emergency settings. K Ke ey y W Wo or rd ds s: : Transplantation; pneumonia; emergency medicine; decision making Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı, acil serviste, yüksek ateşli transplant hastalarında pnömoni tanısının konulmasında acil tıp uzman doktorunun klinik kararının doğruluğunu araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu çalışma bir üniversite hastanesi acil servisinde ileriye dönük, uygun hastalar çalışmaya alınarak gerçekleştirilmiştir. Acil uzman doktorunun acil serviste çalıştığı 08:00-24:00 saatleri arasında, acil servise ana şikayet olarak ateş nedeniyle başvuran tüm solid organ transplantasyonu yapılmış hastalar çalışmaya alınmıştır. Acil Tıp Uzman Doktoru hastanın akciğer grafisi çekilmeden ve değerlendirmeden önce, hastanın pnömoniye ait klinik bulgularına göre, 0-100 mm'lik görsel analog skala kullanarak, 100 mm en kesin değer olacak şekilde, hastanın pnömoni olma olasılığını işaretledi. Çalışma sonucunda akciğer grafisi sonuçları üç grup altında sınıflandırılmıştır: Normal akciğer grafisi, pnömoni (pnömoniyi destekleyecek tanısal pulmoner infiltrasyonlar), anormal fakat pulmoner enfeksiyon değil. B Bu ul lg gu ul la ar r: : Çalışmaya alınan 77 hastanın içinde 10 hastaya pnömoni tanısı konulmuştur. Çalışmaya alınan hasta popülasyonunda, pnömoni tanısının konulmasında acil uzman doktorunun klinik kararının duyarlılığı, seçiciliği, pozitif ve negatif olma olasılığı sırasıyla %70 [%95 g...

show abstract

“…La probabilidad de modificar el diagnóstico inicial de neumonía o la razón de verosimilitud (LR + ) del juicio clínico de los tres médicos de urgencia varió entre 1,5 y 4,8. Hallazgos similares fueron descritos por Wipf y cols, quienes evaluaron la precisión y variabilidad de los examinadores en la pesquisa de los signos clínicos específicos en pacientes con y sin diagnós-tico de neumonía 39 . Los autores concluyeron que los hallazgos semiológicos pesquisados en el examen de tórax no permiten confirmar ni excluir con seguridad el diagnóstico de neumonía, existiendo gran variabilidad interobservador en la pesquisa de hallazgos semiológicos específicos (Tabla 7).…”

Section: A R T í C U L O D E R E V I S I ó Nunclassified

“…consultan por fiebre o síntomas respiratorios agudos [27][28][29][30][31][37][38][39][40][41] . Ninguna de las reglas de decisión descritas en la literatura han sido superiores al juicio clínico en el diagnóstico de neumonía, y aún no existen estudios que hayan examinado su real aporte en la evaluación y manejo de los pacientes que consultan por síntomas respiratorios o fiebre en los servicios de asistencia ambulatoria.…”

Section: Juicio Clínicounclassified

Valor predictivo de la historia clínica y el examen físico en el diagnóstico de la neumonía del adulto adquirida en la comunidad: Revisión de la literatura

R²,

2007

Rev. méd. Chile

View full text Add to dashboard Cite

show abstract

Diagnosing Pneumonia by Physical Examination

Cited by 240 publications

References 14 publications

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings

Valor predictivo de la historia clínica y el examen físico en el diagnóstico de la neumonía del adulto adquirida en la comunidad: Revisión de la literatura

Contact Info

Product

Resources

About