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Chest radiography and pneumonia in primary care: diagnostic yield and consequences for patient management

¹ Dept of Radiology, and ² Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.

CORRESPONDENCE: A. M. Speets, Dept of Radiology (E01.335), University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Fax: 31 302581098. E-mail: aspeets{at}umcutrecht.nl

Keywords: Chest radiography, general practice, patient-care management, pneumonia

Received: January 20, 2006
Accepted June 29, 2006

The current prospective cohort study assessed the diagnostic yield of chest radiography (CXR) in primary-care patients suspected of pneumonia.

In total, 192 patients with a clinical suspicion of pneumonia aged 18 yrs were referred by their general practitioner (GP) for CXR to one of the three participating hospitals in the Netherlands. All GPs were asked to complete a standardised form before and after CXR.

Pneumonia was diagnosed by GPs in 35 (18%) patients, of whom 27 (14%) patients had a positive CXR, and eight (4%) patients a negative CXR, but with an assumed high probability of pneumonia by the GP. CXR clearly influenced the diagnosis of pneumonia by the GP in 53% of the patients. CXR ruled out pneumonia in 47% and the probability of pneumonia substantially increased in 6% of the patients. Patient management changed after CXR in 69% of the patients, mainly caused by a reduction in medication prescription (from 43 to 17%) and more frequent reassurance of the patient (from 8 to 35%).

In conclusion, pneumonia was frequently over diagnosed clinically by general practitioners. Chest radiography is a valuable diagnostic tool to substantially reduce the number of patients misdiagnosed and is particularly important for the exclusion of pneumonia in general practice.