Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad

Background: Community-acquired pneumonia in adults is a serious health problem in the ambulatory care setting. Aim: To define clinical variables associated with the presence of pneumonia in adult patients presenting with fever or respiratory symptoms to the emergency department. Material and methods...

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Autores principales:	Saldías P,Fernando, Cabrera T,Daniel, Solminihac L,Ignacio de, Hernández A,Pamela, Gederlini G,Alessandra, Díaz F,Alejandro
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2007
Materias:	Diagnosis, differential Pneumonia Radiography, thoracic
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000200001
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spelling	oai:scielo:S0034-988720070002000012007-03-28Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidadSaldías P,FernandoCabrera T,DanielSolminihac L,Ignacio deHernández A,PamelaGederlini G,AlessandraDíaz F,Alejandro Diagnosis, differential Pneumonia Radiography, thoracic Background: Community-acquired pneumonia in adults is a serious health problem in the ambulatory care setting. Aim: To define clinical variables associated with the presence of pneumonia in adult patients presenting with fever or respiratory symptoms to the emergency department. Material and methods: Prospective study carried out in the emergency department from the Catholic University Hospital in Santiago, Chile. Three hundred twenty-five patients (53±22 years) presenting fever or acute respiratory symptoms were included. After obtaining a clinical history and physical examination, the physician established a tentative diagnosis. Subsequently, a definitive diagnosis was made with the chest X rays. Results: Thirty-four percent of the patients had pneumonia. The clinical diagnosis of pneumonia before X-ray examination was variable among emergency physicians (positive likelihood ratio: 1.5-4.8) and showed only moderate sensitivity (79%) and specificity (66%). The clinical variables significantly associated with the presence of pneumonia were: advanced age (over 75 years), cardiovascular disease, fever, chills, sputum production, orthopnea, altered mental status, cyanosis, dullness on percussion, bronchial breath sounds, crackles, any abnormal vital sign (heart rate ³100 beats/min, respiratory rate ³20 breaths/min or temperature ³38°C) and oxygen saturation below 90% breathing air. Conclusions: Clinical judgment prior to observation of chest X rays had moderate sensitivity and specificity for the diagnosis of pneumonia. There were no individual clinical findings, or combination of findings, that could confirm or exclude the diagnosis of pneumonia for a patient suspected of having this illnesinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.135 n.2 20072007-02-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000200001es10.4067/S0034-98872007000200001
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Diagnosis, differential Pneumonia Radiography, thoracic
spellingShingle	Diagnosis, differential Pneumonia Radiography, thoracic Saldías P,Fernando Cabrera T,Daniel Solminihac L,Ignacio de Hernández A,Pamela Gederlini G,Alessandra Díaz F,Alejandro Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
description	Background: Community-acquired pneumonia in adults is a serious health problem in the ambulatory care setting. Aim: To define clinical variables associated with the presence of pneumonia in adult patients presenting with fever or respiratory symptoms to the emergency department. Material and methods: Prospective study carried out in the emergency department from the Catholic University Hospital in Santiago, Chile. Three hundred twenty-five patients (53±22 years) presenting fever or acute respiratory symptoms were included. After obtaining a clinical history and physical examination, the physician established a tentative diagnosis. Subsequently, a definitive diagnosis was made with the chest X rays. Results: Thirty-four percent of the patients had pneumonia. The clinical diagnosis of pneumonia before X-ray examination was variable among emergency physicians (positive likelihood ratio: 1.5-4.8) and showed only moderate sensitivity (79%) and specificity (66%). The clinical variables significantly associated with the presence of pneumonia were: advanced age (over 75 years), cardiovascular disease, fever, chills, sputum production, orthopnea, altered mental status, cyanosis, dullness on percussion, bronchial breath sounds, crackles, any abnormal vital sign (heart rate ³100 beats/min, respiratory rate ³20 breaths/min or temperature ³38°C) and oxygen saturation below 90% breathing air. Conclusions: Clinical judgment prior to observation of chest X rays had moderate sensitivity and specificity for the diagnosis of pneumonia. There were no individual clinical findings, or combination of findings, that could confirm or exclude the diagnosis of pneumonia for a patient suspected of having this illnes
author	Saldías P,Fernando Cabrera T,Daniel Solminihac L,Ignacio de Hernández A,Pamela Gederlini G,Alessandra Díaz F,Alejandro
author_facet	Saldías P,Fernando Cabrera T,Daniel Solminihac L,Ignacio de Hernández A,Pamela Gederlini G,Alessandra Díaz F,Alejandro
author_sort	Saldías P,Fernando
title	Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
title_short	Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
title_full	Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
title_fullStr	Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
title_full_unstemmed	Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
title_sort	valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad
publisher	Sociedad Médica de Santiago
publishDate	2007
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000200001
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Valor predictivo de la historia clínica y examen físico en el diagnóstico de neumonía del adulto adquirida en la comunidad

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