Clinical studyPerformance of a bedside c-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough☆
Section snippets
Patient sample and setting
Consecutive adults (age ≥18 years) seeking care at the emergency department or acute care ambulatory clinic of the University of California, San Francisco, between January and April 2002, with acute cough (defined as the development of a new cough illness within the past 3 weeks) were eligible for the study. Patients with any of the following self-reported comorbid conditions that alter C-reactive protein levels were excluded: pregnancy, systemic inflammatory disorders (e.g., rheumatoid
Results
Between January and March 2002, 173 adults with acute cough were enrolled in the study, of whom 25 were diagnosed with radiographic pneumonia. Five pneumonia patients were excluded because C-reactive protein levels were not determined; of the remaining 20 patients, 12 were admitted to the hospital. Other causes of cough included bronchitis (n = 30; 20%), unspecified upper respiratory tract infection (n = 102; 69%), and other (e.g., asthma) (n = 16; 11%). One patient without pneumonia was
Discussion
We evaluated the performance of a rapid, bedside C-reactive protein test in the evaluation of adults presenting with acute cough, and found that levels ≥100 mg/L were highly specific for a diagnosis of pneumonia, whereas only a small minority of pneumonia patients (3 of 20) had levels <11 mg/L. When measured at initial presentation, C-reactive protein levels did not discriminate which patients with pneumonia required hospitalization, nor did it correlate with resolution of symptoms 2 to 4 weeks
References (29)
- et al.
Prediction of pneumonia in outpatients with acute cough—a statistical approach
J Chronic Dis
(1984) - et al.
Decision rules and clinical prediction of pneumoniaevaluation of low-yield criteria
Ann Emerg Med
(1989) - et al.
Clinical criteria for the detection of pneumonia in adultsguidelines for ordering chest roentgenograms in the emergency department
J Emerg Med
(1989) - et al.
Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward
Eur J Intern Med
(2000) - et al.
C-reactive protein in simple community-acquired pneumonia
Chest
(1995) - et al.
Likelihood ratios with confidencesample size estimation for diagnostic test studies
J Clin Epidemiol
(1991) - et al.
C-reactive proteina clinical marker in community-acquired pneumonia
Chest
(1995) - et al.
Interobserver reliability of the chest radiograph in community- acquired pneumonia. PORT Investigators
Chest
(1996) - et al.
Comparison of physician judgment and decision aids for ordering chest radiographs for pneumonia in outpatients
Ann Emerg Med
(1991) - Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments and emergency departments:...
National trends in the use of antibiotics by primary care physicians for adults with cough
Arch Intern Med
Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adultsbackground, specific aims, and methods
Ann Intern Med
Clinical prediction rule for pulmonary infiltrates
Ann Intern Med
Does this patient have community acquired pneumonia? Diagnosing pneumonia by history and physical examination
JAMA
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This study was supported by the Robert Wood Johnson Minority Medical Faculty Development Program. C-reactive protein test kits were provided by the manufacturer (Axis-Shield, Oslo, Norway).