Volume 19 Issue 3 September 2010Original Research
Diagnosis and management of pneumonia and bronchitis in
outpatient primary care practices
Pages 237-241
*Jennifer Evertsena,b, Dennis J Baumgardnera,b,c, Ann Regnerya, Indrani Banerjeeb
a
University of Wisconsin School of Medicine and Public Health, Milwaukee, USA
b
Center for Urban Population Health, Milwaukee, USA
c
Aurora UW Medical Group, Milwaukee, USA
Received 30 September 2009 • Accepted 11 March 2010 • Online 21 May 2010
Abstract
AIMS: To understand which clinical criteria physicians use to diagnose pneumonia compared to bronchitis and upper respiratory tract
infection (URTI).
METHODS: Retrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.
RESULTS: Logistic regression analysis identified rales, a temperature > 100°F (37.8°C), chest pain, dyspnoea, rhonchi, heart rate, respiratory
rate, and rhinorrhoea, as the best explanation for the variation in diagnosis of pneumonia compared to either of the alternative diagnoses
(R2 = 59.3), with rales and a temperature > 100°F explaining 30% of the variation. Rales, chest pain, and a temperature > 100°F best
predicted the ordering of a chest x-ray (R2 = 20.0). However, 35% (59/175) of patients diagnosed with pneumonia had a negative chest
x-ray. Abnormal breath sounds were the best predictors for prescribing antibiotics (R2 = 38%). A significant number of patients with acute
bronchitis (93% excluding sinusitis) and URTI (42%) were given antibiotics.
CONCLUSIONS: The presence of abnormal breath sounds and a temperature > 100°F were the best predictors of a diagnosis of pneumonia.
Keywords
Pneumonia, bronchitis, antibiotics, URTI, prediction rule, management, primary care
* Corresponding author. Jennifer Evertsen Tel: 001 414 219 5594 Fax: 001 414 219 6563 Email: evertsen@wisc.edu | |
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