Pneumonia: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
A [[clinical prediction rule]] found the five following signs best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room:<ref name="pmid2221647">{{cite journal |author=Heckerling PS, Tape TG, Wigton RS, ''et al'' |title=Clinical prediction rule for pulmonary infiltrates |journal=Ann. Intern. Med. |volume=113 |issue=9 |pages=664–70 |year=1990 |pmid=2221647 |doi=}}</ref> | ===History and physical examination=== | ||
A [[clinical prediction rule]] found the five following signs from the medical history and [[physical examination]] best predicted infiltrates on the chest [[radiography|radiograph]] of 1134 patients presenting to an emergency room:<ref name="pmid2221647">{{cite journal |author=Heckerling PS, Tape TG, Wigton RS, ''et al'' |title=Clinical prediction rule for pulmonary infiltrates |journal=Ann. Intern. Med. |volume=113 |issue=9 |pages=664–70 |year=1990 |pmid=2221647 |doi=}}</ref> | |||
*Temperature > 100 degrees F (37.8 degrees C) | *Temperature > 100 degrees F (37.8 degrees C) | ||
*Pulse > 100 beats/min | *Pulse > 100 beats/min | ||
Revision as of 06:46, 27 June 2008
| Pneumonia | |
|---|---|
| ICD-9 | 480
-486 |
Pneumonia is defined as "inflammation of the lungs."[1]
Classification
Pneumonia can be classified along various dimensions including clinical setting, underlying etiology, and its gross appearance (bronchopneumonia versus lobar pneumonia).
Aspiration pneumonia
Community acquired pneumonia
Atypical pneumonia
Nosocomial pneumonia
Ventilator associated pneumonia
Diagnosis
History and physical examination
A clinical prediction rule found the five following signs from the medical history and physical examination best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room:[2]
- Temperature > 100 degrees F (37.8 degrees C)
- Pulse > 100 beats/min
- Crackles
- Decreased breath sounds
- Absence of asthma
The probability of an infiltrate in two separate validations was based on the number of findings:
- 5 findings - 84% to 91% probability
- 4 findings - 58% to 85%
- 3 findings - 35% to 51%
- 2 findings - 14% to 24%
- 1 findings - 5% to 9%
- 0 findings - 2% to 3%
A subsequent study[3] comparing four clinical prediction rules to physician judgment found that two clinical prediction rules, the one above[2] and another[4] were more accurate than physician judgment because of the increased specificity of the prediction rules.
Treatment
Antibiotics
Aspiration pneumonia
Community acquired pneumonia
The optimal duration of antibiotic treatment for community acquired pneumonia is not clear.[5]
Ventilator associated pneumonia
Treatments that are ineffective
Chest physiotherapy includes postural drainage, percussion, and vibration and has been call the 'ketchup-bottle method'[6] of treating pneumonia. Chest physiotherapy and intermittent positive-pressure breathing have been shown not to help in a small randomized controlled trial.[7]
Prognosis
Short term prognosis and the decision to hospitalize
The prognosis of community acquired pneumonia can be estimated with either of two clinical prediction rules:
- Pneumonia severity index (PSI) - the PSI may be the most accurate[8] and is available online (Pneumonia Severity Index Calculator).
- CURB-65
Long term prognosis
References
- ↑ Anonymous (2024), Pneumonia (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 Heckerling PS, Tape TG, Wigton RS, et al (1990). "Clinical prediction rule for pulmonary infiltrates". Ann. Intern. Med. 113 (9): 664–70. PMID 2221647. [e]
- ↑ Emerman CL, Dawson N, Speroff T, et al (1991). "Comparison of physician judgment and decision aids for ordering chest radiographs for pneumonia in outpatients". Annals of emergency medicine 20 (11): 1215–9. DOI:10.1016/S0196-0644(05)81474-X. PMID 1952308. Research Blogging.
- ↑ Gennis P, Gallagher J, Falvo C, Baker S, Than W (1989). "Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department". The Journal of emergency medicine 7 (3): 263–8. PMID 2745948. [e]
- ↑ Li JZ, Winston LG, Moore DH, Bent S (2007). "Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis". Am. J. Med. 120 (9): 783–90. DOI:10.1016/j.amjmed.2007.04.023. PMID 17765048. Research Blogging.
- ↑ Murray JF (1979). "The ketchup-bottle method". N. Engl. J. Med. 300 (20): 1155–7. PMID 431639. [e]
- ↑ Graham WG, Bradley DA (1978). "Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia". N. Engl. J. Med. 299 (12): 624–7. PMID 355879. [e]
- ↑ Aujesky D, Auble TE, Yealy DM, et al (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384-92. DOI:10.1016/j.amjmed.2005.01.006. PMID 15808136. Research Blogging.
External links
- Pneumonia Severity Index Calculator
- Pneumonia - Information for patients from MedlinePlus (United States National Library of Medicine).