Pneumonia diagnostic algorithm: Difference between revisions
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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</small> | ||
<div style="font-size:85%; width: | <div style="font-size:85%; width: 80%; float:left"> | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | A01 | | | | | | | | | | | | A01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | A01 | | | | | | | | | | | | A01=<div style="float: left; text-align: left; width: 28em; padding:1em;"> '''Symptoms that suggest a respiratory tract infection:'''<br>❑ [[Fever]] <br>❑ [[Cough]] with sputum <br>❑ [[Dyspnea]]<br>❑ [[Pleuritic]] chest pain</div> }} | ||
{{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | {{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | B01 | | | | | | | | | | | | B01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | B01 | | | | | | | | | | | | B01=<div style="float: left; text-align: left; width: 28em; padding:1em;">'''Physical Examination Findings:''' <br> | ||
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</div>}} | </div>}} | ||
{{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | {{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | C01 | | | | | | | | | | | | C01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | C01 | | | | | | | | | | | | C01=<div style="float: left; text-align: left; width: 28em; padding:1em;">'''Order Labs:'''<br> ❑ [[Complete blood count]] (CBC) <br>❑ [[Blood urea nitrogen]] (BUN) <br>❑ [[Gram staining|Sputum gram stain]] <br>❑ [[Sputum culture]] <br>❑ [[Blood culture]] if necessary<br>❑ If suspecting [[atypical pneumonia]] obtain: <br> | ||
:❑ Urine [[legionella]] antigen<br> | :❑ Urine [[legionella]] antigen<br> | ||
:❑ [[Enzyme linked immunosorbent assay (ELISA)|Enyzme Immunoassay (EIA)]] <br> | :❑ [[Enzyme linked immunosorbent assay (ELISA)|Enyzme Immunoassay (EIA)]] <br> | ||
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:❑ [[Polymerase chain reaction]] (PCR) for atypical and viral including [[influenza]]<br></div>}} | :❑ [[Polymerase chain reaction]] (PCR) for atypical and viral including [[influenza]]<br></div>}} | ||
{{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | {{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | D01 | | | | | | | | | | | | D01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | D01 | | | | | | | | | | | | D01=<div style="float: left; text-align: left; width: 28em; padding:1em;">❑ Order a chest X-ray if the patient presents with any of the following:<ref name="pmid21661712">{{cite journal| author=Watkins RR, Lemonovich TL| title=Diagnosis and management of community-acquired pneumonia in adults. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 11 | pages= 1299-306 | pmid=21661712 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21661712}} </ref> | ||
* [[Fever]] (>37.8° C / 100° F) | * [[Fever]] (>37.8° C / 100° F) | ||
* [[Tachypnea]] (> 20 breaths/min) | * [[Tachypnea]] (> 20 breaths/min) | ||
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* Decreased [[breath sounds]] and [[crackles]] in the physical exam </div>}} | * Decreased [[breath sounds]] and [[crackles]] in the physical exam </div>}} | ||
{{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | {{familytree | | | | | | | | |!| | | | | | | | | | | | | }} | ||
{{familytree | | | | | | | | E01 | | | | | | | | | | | | E01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | E01 | | | | | | | | | | | | E01=<div style="float: left; text-align: left; width: 28em; padding:1em;">Does the patient meets any of the following criteria for HCAP?<ref name="pmid21663884">{{cite journal |author=Attridge RT, Frei CR |title=Health care-associated pneumonia: an evidence-based review |journal=[[The American Journal of Medicine]] |volume=124 |issue=8 |pages=689–97 |year=2011 |month=August |pmid=21663884 |doi=10.1016/j.amjmed.2011.01.023 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(11)00291-9 |accessdate=2012-09-02}}</ref><br> | ||
* Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; | * Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; | ||
* Resided in a nursing home or long-term care facility; | * Resided in a nursing home or long-term care facility; | ||
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* Invasive [[mechanical ventilation]] | * Invasive [[mechanical ventilation]] | ||
* [[Septic shock]] with the need for [[vasopressors]]</small></div></div></div>}} | * [[Septic shock]] with the need for [[vasopressors]]</small></div></div></div>}} | ||
{{familytree | |,|-|-|^|-|.| | | |,|-|^ | {{familytree | |,|-|-|^|-|.| | | |,|-|^|-|.| | | | | }} | ||
{{familytree | H01 | | | H02 | | H03 | | | H04 | {{familytree | H01 | | | H02 | | H03 | | | H04 | | | H01=<div style="float: left; text-align: center; width: 10em; padding:1em;">'''YES'''</div> |H02=<div style="float: left; text-align: center; width: 10em; padding:1em;">'''NO''' <br> The patient has '''HCAP''' </div> |H03=<div style="float: left; text-align: center; width: 10em; padding:1em;">'''YES''' <br> Admit the patient and administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|inpatient antibiotic regimen]]</div> |H04=<div style="float: left; text-align: center; width: 10em; padding:1em;">'''NO''' <br> Administer [[Community-acquired pneumonia medical therapy#Empirical Treatment|outpatient antibiotic regimen]]</div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
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Revision as of 17:24, 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
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 meets any of the Severity Criteria? Minor Criteria
Major criteria
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YES | NO The patient has HCAP | YES Admit the patient and administer inpatient antibiotic regimen | NO Administer 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)