Clinical InvestigationAdmission Chest Radiograph Lacks Sensitivity in the Diagnosis of Community-Acquired Pneumonia
Section snippets
Patient Selection
Patients with CAP admitted to the University Hospital at the University of Cincinnati Medical Center (an urban 450 bed academic medical center) were identified retrospectively by the ICD-9 codes (480.0–487.0) available through hospital information systems. Charts were reviewed to ensure that the final clinical diagnosis of CAP was made by the physician at discharge. The only inclusion criterion was the final clinical diagnosis as determined by the attending physician. Of 520 patients admitted
RESULTS
Twenty-one percent (22/105) of patients with a diagnosis of CAP had negative initial chest radiographs. Patients with negative chest radiographs were not different in age or gender when compared with those with positive radiographs (Table 1). Disease severity, as calculated by the PSI, was 75.1 on average for those with positive chest radiographs and 81.9 for those with negative initial studies (P = 0.28). The PSI was not able to be calculated due to HIV infection for 12 patients with positive
DISCUSSION
In this study, 21% of patients admitted with a clinical diagnosis of CAP had a negative initial chest radiograph. Similarly, Basi et al16 found 1/3 of patients admitted to Canadian hospitals and managed using a CAP pathway did not have chest radiograph findings indicative of pneumonia. Unlike most previous investigations of CAP, our study and the investigation by Basi et al16 used the actual clinical diagnosis as inclusion criteria. Additionally, when 2 expert thoracic radiologists reviewed 282
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2021, Clinical Microbiology and InfectionCitation Excerpt :Finally, the very restrictive disease definition must also be mentioned as a limitation. Some CAP patients develop infiltrates at a later stage or have very discrete radiological changes [28]. These patients were not captured by our study.
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2020, Journal of Emergency MedicineCitation Excerpt :Internationally accepted guidelines recommend that the diagnosis should be made based on clinical features, but it lacks specificity and may overlap with viral infections (14–16). Historically, CXR study has been the imaging modality of choice when clinical features alone are unreliable or in more severe cases, but it cannot be considered a gold standard because it lacks sensitivity and specificity (17,18). An important consideration is that radiographic examinations expose patients to harmful ionizing radiation during a time at which they are believed to be most at risk of harm (19).