CXR and pneumonia in primary care: diagnostic yield & consequences for patient management

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

^* To whom correspondence should be addressed. E-mail: aspeets{at}umcutrecht.nl.

	Abstract

This 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 years were referred by their general practitioner (GP) for CXR to one of the three participating hospitals in The Netherlands. All GPs were asked to fill in a standardized form before and after CXR.

Pneumonia was diagnosed by GPs in 35 patients (18%), of whom 27 patients (14%) had a positive CXR, and 8 patients (4%) a negative CXR, however 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%).

Pneumonia was frequently over diagnosed clinically by GPs. CXR is a valuable diagnostic tool to substantially reduce the number of patients misdiagnosed, and particularly important for the exclusion of pneumonia in general practice.