Derivation of a triage algorithm for chest radiography of community-acquired pneumonia patients in the emergency department

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Demetrios N KyriacouJames G Adams

Abstract

Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year. To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP. The authors conducted an ED-based retrospective matched case-control study using 100 radiographic confirmed CAP cases and 100 radiographic confirmed influenzalike illness (ILI) controls. Sensitivities and specificities of characteristics assessed in the triage setting were measured to discriminate CAP from ILI. The authors then used classification tree analysis to derive an algorithm that maximizes sensitivity and specificity for detecting patients with CAP in the ED triage setting. Temperature greater than 100.4 degrees F (likelihood ratio = 4.39, 95% confidence interval [CI] = 2.04 to 9.45), heart rate greater than 110 beats/minute (likelihood ratio = 3.59, 95% CI = 1.82 to 7.10), and pulse oximetry less than 96% (likelihood ratio = 2.36, 95% CI = 1.32 to 4.20) were the strongest predictors of CAP. However, no single characteristic was adequately sensitive and specific to accurately discriminate CAP from ILI. A three-step algorithm (using optimum cut points for elevat...Continue Reading

References

Jan 1, 1989·Annals of Emergency Medicine·B M SingalK L Radack
Jul 14, 1997·Archives of Internal Medicine·J P MetlayM J Fine
Aug 25, 1999·Annals of Emergency Medicine·D N KyriacouD A Talan
Jan 17, 2003·Annals of Internal Medicine·Joshua P Metlay, Michael J Fine
Apr 26, 2007·JAMA : the Journal of the American Medical Association·Mike Mitka
Jul 4, 2007·The American Journal of Emergency Medicine·Brendon R NoltJoshua P Metlay

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Citations

Sep 29, 2012·Lung India : Official Organ of Indian Chest Society·Dheeraj GuptaUNKNOWN Pneumonia Guidelines Working Group
Jan 22, 2014·The American Journal of Emergency Medicine·Greg P MarconiAlan L Nager
Mar 15, 2013·The Journal of Emergency Medicine·Andrew SucovSteven E Reinert
Jun 23, 2009·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Scott G WeinerCheryl A Webber

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