Pneumonia: Diagnostic Criteria The “gold standard” for diagnosis of CAP is chest radiography. If pneumonia is suspected based on history of present illness, subjective symptoms, and physical exam, the clinician should obtain a standard chest x ray with PA and lateral views. Patients that may benefit from a chest xray include the following: Temperature >100 HR >100 RR > 20 Decreased breath sounds Crackles Absence of asthma (Watkins & Lemonovich, 2011) On plain films, typical bacteria may be suspected when lobar consolidation, cavitation, or pleural effusion is present. Diffuse infiltration (bilateral “white outs”) are more often associated with an atypical pathogen. Lobar consolidation in the right lower lobe Bilateral infiltrates (aka: “white outs”) A normal chest xray; no pneumonia present In the outpatient setting, sputum cultures are not indicated. If the clinician suspects a pathogen that would alter the patient’s treatment regimen from the guidelines, laboratory testing can be performed. Clinical findings that may indicate specific laboratory evaluation can be found in table 3 of the article by Watkins & Lemonovich (2011). Empiric therapy after diagnosis via chest radiography is generally the standard. Severity index- Inpatient vs. outpatient Pneumonia is an illness with considerable morbidity and mortality. After diagnosis is confirmed, it is important to assess whether or not outpatient treatment is safe. Patients with acute illness may need hospitalization. Both the Pneumonia Severity Index and the CURB-65 scales can be used to assist the clinician in determining whether inpatient or outpatient treatment is appropriate. Pneumonia Severity Index (PSI) The PSI classifies the patients risk from class I through V. Class I patients can be treated at home with oral antibiotics. Classes II and III should be treated with either brief hospitalization (~24 hrs) or treated at home with IV antibiotics. Classes IV and V should be hospitalized. The PSI algorithm is listed below: Step 1: Stratify to Risk Class I vs. Risk Classes II-V Presence of: Over 50 years of age Yes/No Altered mental status Yes/No Pulse ≥125/minute Yes/No Respiratory rate >30/minute Yes/No Systolic blood pressure
Posted on: Wed, 02 Jul 2014 00:24:54 +0000
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