DIAGNOSTICO Y MANEJO DE NEUMONIA Y BRONQUITIS EN ATENCION PRIMARIA
Diagnosis and management of pneumonia and bronchitis in outpatient primary care practices
a University of Wisconsin School of Medicine and Public Health, Milwaukee, USA
b Center for Urban Population Health, Milwaukee, USA
c Aurora UW Medical Group, Milwaukee, USA
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.
http://www.thepcrj.org/journ/aop/pcrj-2009-09-0078-R2.pdf TEXTO COMPLETO