Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices

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 degrees F (37.8 degrees 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 (R-2 = 59.3), with rales and a temperature >= 100 degrees F explaining 30% of the variation. Rates, chest pain, and a temperature >= 100 degrees F best predicted the ordering of a chest x-ray (R-2 = 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 (R-2 = 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 degrees F were the best predictors of a diagnosis of pneumonia. (c) 2010 Primary Care Respiratory Society UK. All rights reserved. J Evertsen et al. Prim Care Resp J 2010; 19(3): 237-241 doi:10.4104/pcrj.2010.00024