Pneumonia diagnostic algorithm: Difference between revisions
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==Diagnostic Algorithm== | ==Diagnostic Algorithm== | ||
Shown below is an algorithm for the diagnostic approach of pneumonia.<ref name="cid.oxfordjournals.org">{{Cite web | last = | first = | title = http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html | url = http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html | publisher = | date = | accessdate = 13 March 2014 }}</ref><ref name="SolomonWunderink2014">{{cite journal|last1=Solomon|first1=Caren G.|last2=Wunderink|first2=Richard G.|last3=Waterer|first3=Grant W.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=370|issue=6|year=2014|pages=543–551|issn=0028-4793|doi=10.1056/NEJMcp1214869}}</ref> | Shown below is an algorithm for the diagnostic approach of pneumonia.<ref name="cid.oxfordjournals.org">{{Cite web | last = | first = | title = http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html | url = http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html | publisher = | date = | accessdate = 13 March 2014 }}</ref><ref name="SolomonWunderink2014">{{cite journal|last1=Solomon|first1=Caren G.|last2=Wunderink|first2=Richard G.|last3=Waterer|first3=Grant W.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=370|issue=6|year=2014|pages=543–551|issn=0028-4793|doi=10.1056/NEJMcp1214869}}</ref> | ||
<br><small>'''Abbreviations:''' '''HCAP:''' Healthcare-associated pneumonia; '''CAP:''' Community-acquired pneumonia</small> | <br><small>'''Abbreviations:''' '''HCAP:''' Healthcare-associated pneumonia; '''CAP:''' Community-acquired pneumonia; '''VAP:''' Ventilator-associated pneumonia; '''HAP:''' Hospital-acquired pneumonia; </small> | ||
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{{familytree | | | | F01 | | | | | | F02 | | | | | F01=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''YES'''</div> |F02=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''NO'''<br> The patient has '''CAP'''</div>}} | {{familytree | | | | F01 | | | | | | F02 | | | | | F01=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''YES'''</div> |F02=<div style="float: left; text-align: center; width: 15em; padding:0.5em;">'''NO'''<br> The patient has '''CAP'''</div>}} | ||
{{familytree | | | | |!| | | | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | | |!| | | | | | }} | ||
{{familytree | | | | G01 | | | | | | G02 | | | | | G01=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">Does the infection occurred ≥48 hours after admission and it was not present at admission?</div> |G02=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">'''Does the patient has at least 2 of the following CURB65 criteria? ''' | {{familytree | | | | G01 | | | | | | G02 | | | | | G01=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">'''Does the infection occurred ≥48 hours after admission and it was not present at admission?'''</div> |G02=<div style="float: left; text-align: left; width: 15em; padding:0.5em;">'''Does the patient has at least 2 of the following CURB65 criteria? ''' | ||
* '''C'''onfusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less) | * '''C'''onfusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less) | ||
* '''U'''rea greater than 7 mmol/l (Blood Urea Nitrogen > 20) | * '''U'''rea greater than 7 mmol/l (Blood Urea Nitrogen > 20) | ||
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* Age '''65''' or older</div>}} | * Age '''65''' or older</div>}} | ||
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{{familytree | H01 | | | H02 | | H03 | | | H04 | H01=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''YES'''</div> |H02=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''NO''' <br> The patient has '''HCAP''' </div> |H03=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''YES''' <br> Admit the patient and administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric inpatient antibiotic regimen]]</div> |H04=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''NO''' <br> Administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric outpatient antibiotic regimen]]</div>}} | {{familytree | H01 | | | H02 | | H03 | | | H04 | H01=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''YES'''<br> If the patient had an endotraqueal tube placed, suspect '''VAP'''. Otherwise, the patient has '''HAP'''</div> |H02=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''NO''' <br> The patient has '''HCAP''' </div> |H03=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''YES''' <br> Admit the patient and administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric inpatient antibiotic regimen]]</div> |H04=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''NO''' <br> Administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|empiric outpatient antibiotic regimen]]</div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
</div> | </div> | ||
Revision as of 19:01, 8 December 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
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Overview
Diagnostic Algorithm
Shown below is an algorithm for the diagnostic approach of pneumonia.[1][2]
Abbreviations: HCAP: Healthcare-associated pneumonia; CAP: Community-acquired pneumonia; VAP: Ventilator-associated pneumonia; HAP: Hospital-acquired pneumonia;
Physical Examination Findings:
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Order Labs: ❑ Complete blood count (CBC) ❑ Blood urea nitrogen (BUN) ❑ Sputum gram stain ❑ Sputum culture ❑ Blood culture if necessary ❑ If suspecting atypical pneumonia obtain:
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❑ Order a chest X-ray if the patient presents with any of the following:[3]
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Does the patient meets any of the following criteria for HCAP?[4]
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YES | NO The patient has CAP | ||||||||||||||||||||||||||||||||||||||
Does the infection occurred ≥48 hours after admission and it was not present at admission? | Does the patient has at least 2 of the following CURB65 criteria?
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YES If the patient had an endotraqueal tube placed, suspect VAP. Otherwise, the patient has HAP | NO The patient has HCAP | YES Admit the patient and administer empiric inpatient antibiotic regimen | NO Administer empiric outpatient antibiotic regimen | ||||||||||||||||||||||||||||||||||||
References
- ↑ "http://cid.oxfordjournals.org/content/44/Supplement_2/S27.full.pdf+html". Retrieved 13 March 2014. External link in
|title=(help) - ↑ Solomon, Caren G.; Wunderink, Richard G.; Waterer, Grant W. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 370 (6): 543–551. doi:10.1056/NEJMcp1214869. ISSN 0028-4793.
- ↑ Watkins RR, Lemonovich TL (2011). "Diagnosis and management of community-acquired pneumonia in adults". Am Fam Physician. 83 (11): 1299–306. PMID 21661712.
- ↑ Attridge RT, Frei CR (2011). "Health care-associated pneumonia: an evidence-based review". The American Journal of Medicine. 124 (8): 689–97. doi:10.1016/j.amjmed.2011.01.023. PMID 21663884. Retrieved 2012-09-02. Unknown parameter
|month=ignored (help)