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

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.