The Role of Physical Examination in Establishing the Diagnosis of Pneumonia

Ayalon, Itay; Glatstein, Miguel; Zaidenberg-Israeli, Þ Galit; Scolnik, Dennis; Ben‐Tov, Amir; Ben-Sira, Liat; Reif, Shimon

doi:10.1097/pec.0b013e31829e7d6a

Cited by 17 publications

(22 citation statements)

References 14 publications

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“…GBS pneumonia mimics RDS,25 and should be considered if a baby with radiographic appearances of RDS, is disproportionately sick. NICE guidelines5 do not give a directive on the role of chest radiography as part of a screen for EONS, however, it is notable that even in older children pneumonia may be present with limited clinical signs, and there is significant added value of chest radiography in the diagnosis of pneumonia 26…”

Section: The Role Of Chest Radiographmentioning

confidence: 99%

Early onset neonatal sepsis: diagnostic dilemmas and practical management

Russell

Kumar

2014

Arch Dis Child Fetal Neonatal Ed

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Early onset neonatal sepsis is persistently associated with poor outcomes, and incites clinical practice based on the fear of missing a treatable infection in a timely fashion. Unnecessary exposure to antibiotics is also hazardous. Diagnostic dilemmas are discussed in this review, and suggestions offered for practical management while awaiting a more rapidly available 'gold standard' test; in an ideal world, this test would be 100% sensitive and 100% specific for the presence of organisms.

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Section: The Role Of Chest Radiographmentioning

confidence: 99%

Early onset neonatal sepsis: diagnostic dilemmas and practical management

Russell

Kumar

2014

Arch Dis Child Fetal Neonatal Ed

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“…Based on study selection criteria, 1 Class II study 41 and 8 Class III studies [42][43][44][45][46][47][48][49] were included to answer this critical question.…”

Section: For Wellmentioning

confidence: 99%

“…Oxygen saturation has been shown to be lower in subjects with radiographic pneumonia in 4 Class III studies; however, these studies did not agree on a specific cutoff value. [45][46][47][48] In a study by Simon et al, 45 hypoxia was found to be predictive of radiographic pneumonia but had inadequate sensitivity and specificity to recommend a specific cutoff value for oxygen saturation; in fact, radiographic pneumonia was found in half of patients with an oxygen saturation of 96% or higher. Therefore, the absence of hypoxia in their study group did not rule out radiographic pneumonia.…”

Section: For Wellmentioning

confidence: 99%

Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

Eskin¹,

Bakes²,

Brown³

et al. 2016

Annals of Emergency Medicine

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“…Despite frequent use of X-ray in clinical settings, there are still debates regarding its necessity in patients suspected of having CAP. In this regard, Ayalon et al investigated the role of physical examination in the diagnosis of pneumonia and demonstrated the significant benefit of CXR as an ancillary test for the diagnosis of pneumonia in ED settings (7). In addition, according to a review published in 2003, CXR was considered as the gold standard for diagnosing pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of a Chest X-ray for Community-Acquired Pneumonia

et al. 2014

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Background:Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia.Objectives:This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP).Patients and Methods:A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared.Results:The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%).Conclusions:This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood of morbidity if CAP is not initially detected.

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The Role of Physical Examination in Establishing the Diagnosis of Pneumonia

Abstract: Results demonstrate the significant added value of chest radiography as an ancillary test for diagnosis of pneumonia in the emergency department setting.

Cited by 17 publications

References 14 publications

Early onset neonatal sepsis: diagnostic dilemmas and practical management

Early onset neonatal sepsis: diagnostic dilemmas and practical management

Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of a Chest X-ray for Community-Acquired Pneumonia

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