TY - JOUR
T1 - Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness
AU - Nolt, Brendon R.
AU - Gonzales, Ralph
AU - Maselli, Judy
AU - Aagaard, Eva
AU - Camargo, Carlos A.
AU - Metlay, Joshua P.
N1 - Funding Information:
Funded by the Translating Research into Practice initiative, jointly sponsored by the Agency for Healthcare Research and Quality (grant no. 1 R01 HS013915) and the Health Services Research and Development Service of the Department of Veterans Affairs (AVA-03-239).
PY - 2007/7
Y1 - 2007/7
N2 - Purpose: This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. Methods: A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. Results: Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. Conclusions: Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
AB - Purpose: This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. Methods: A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. Results: Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. Conclusions: Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
UR - http://www.scopus.com/inward/record.url?scp=34250886822&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2006.11.031
DO - 10.1016/j.ajem.2006.11.031
M3 - Article
C2 - 17606087
AN - SCOPUS:34250886822
SN - 0735-6757
VL - 25
SP - 631
EP - 636
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 6
ER -