TY - JOUR T1 - Detecting pneumonia in patients with acute cough in primary: Results from the European GRACE study JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - 4512 AU - Saskia van Vugt AU - Lidewij Broekhuizen AU - Peter Zuithoff AU - Pim de Jong AU - Greet Ieven AU - Herman Goossens AU - Christine Lammens AU - Samuel Coenen AU - Chris Butler AU - Paul Little AU - Theo Verheij Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/4512.abstract N2 - Introduction: It is still unclear what the best strategy to detect pneumonia in primary care patients should be.Aim: To quantify the diagnostic value of history, physical examination and the added value of inflammation markers in detecting pneumonia in patients presenting with acute cough in primary care.Methods: 2820 adult patients attending their general practioner with complaints of cough ≤28 days, were recruited from 12 European countries. Patient's history and physical examination were recorded on the day of presentation. C-reactive protein (CRP) and pro-calcitonin (PCT) were drawn from venous blood samples and chest radiographs were taken within the next three days. Pneumonia was diagnosed by chest X-ray. With multivariable logistic regression a diagnostic model was developed for diagnosing or ruling out pneumonia.Results: 140 patients had radiographic pneumonia (5%). Symptoms and signs with independent diagnostic value were; absence of runny nose, presence of breathlessness, diminished vesicular breathing and crackles on auscultation, tachycardia (pulse >100/min), and temperature >37.8°C. Combined these items showed an area under the ROC curve of 0.70 (95% confidence interval 0.65-0.75). A combination of the 2 strongest predictors (crackles and temperature >37.8, n=30) had a positive predictive value for pneumonia of 37%. Analysis of the added value of CRP and PCT is in progress; results will be available in the presentation.Conclusions: Radiographic pneumonia is uncommon in adults presenting in primary care with acute cough. Brief history and physical examination can help discriminate between those at high and low risk for pneumonia. ER -