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Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Kärna Vårdcent, Linkoping, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Ljungsbro Vårdcent, Sweden.
Linköping University, Department of Medical and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Medicine and Health Sciences.
Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
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2016 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, 21-27 p.Article in journal (Refereed) Published
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Text
Abstract [en]

Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p<0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p<0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2016. Vol. 34, no 1, 21-27 p.
Keyword [en]
Chest radiography; clinical assessment; community-acquired pneumonia; C-reactive protein; general practice; primary care; Sweden
National Category
Basic Medicine
Identifiers
URN: urn:nbn:se:liu:diva-127062DOI: 10.3109/02813432.2015.1132889ISI: 000372023200005PubMedID: 26849394OAI: oai:DiVA.org:liu-127062DiVA: diva2:919376
Note

Funding Agencies|County Council of ostergotland

Available from: 2016-04-13 Created: 2016-04-13 Last updated: 2017-05-02

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Garvin, PeterFransson, Sven GöranFalk, Magnus

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Moberg, A. B.Taleus, U.Garvin, PeterFransson, Sven GöranFalk, Magnus
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Division of Community MedicineFaculty of Medicine and Health SciencesPrimary Health Care in Central CountyDepartment of Medical and Health SciencesResearch & Development Unit in Local Health CareDepartment of Radiology in LinköpingDivision of Radiological Sciences
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