Can history and exam alone reliably predict pneumonia?

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Original Research

Can history and exam alone reliably predict pneumonia?

J Fam Pract. 2007 June;56(6):465-470

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References

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A study by Macfarlane et al²² showed that abnormalities on X-ray generally persist for quite a long time—4 weeks after the diagnosis of pneumonia only 50% of the abnormalities had resolved. However, a study by Mittl et al²³ showed complete resolution in 50% of the patients after 2 weeks, with even more rapid clearance in the younger age groups (up to 60% at the age of 20). Interpolation of these findings showed resolution of symptoms after 1 week of 5% to 10% and 5% to 30%, respectively. In our study, a possible 3-week delay between onset of symptoms and chest radiographs could have resulted in resolution of pneumonia in a few patients.

FAST TRACK

The effect of antibiotics on the study is unclear—some cases may have resolved between onset of symptoms and X-ray

However, our patient population, with a mean age of 50 years, is somewhat older than that in Mittl’s population,²³ with its mean age of 40 years. The study by Mittl showed that resolution of pneumonia occurred less rapidly in older patients. Because our population was older Mittl’s population, the resolution of pneumonia could have been less in our population.

Treatment may have influenced results. How quickly antibiotic use affected radiologic findings remains unclear. Nearly all patients in our study were treated with antibiotics, as in the study by Mittl.²³ In our study the mean time between onset of the symptoms and inclusion was 9 days; Macfarlane²² and Mittl²³ did not show these data, so we could not compare findings.

Acknowledgments

We wish to thank the patients and GPs who participated in the study. We would also like to thank Professor W J J Assendelft (Leiden university Medical Center) for his constructive criticism and H Bolk-Lucieer for reviewing the manuscript. This work was made possible by a grant from the european Commission Framework V and from Pfizer. Ethical approval has been granted by the Medical Ethics Committee of the Leiden University Medical Center.

Correspondence
A W Graffelman, MD, PhD, Department of General Practice and Nursing Home Medicine, LUMC, PO Box 2088, 2301 CB Leiden, The Netherlands a.w.graffelman@lumc.nl