Derivation of a Triage Algorithm for Chest Radiography of Community-acquired Pneumonia Patients in the Emergency Department.
BACKGROUND: Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year. OBJECTIVES: To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP. METHODS: The...
| Publicado en: | Academic Emergency Medicine Vol. 15; no. 1; pp. 40 - 45 |
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| Autores principales: | , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Wiley-Blackwell
Jan2008
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105422544&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105422544 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10696563 Z27 jtl: Academic Emergency Medicine issn: 10696563 maglogo: Y pubinfo: dt: Jan2008 vid: 15 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 105422544 105422544 2010386584 10.1111/j.1553-2712.2007.00011.x NLM18211312 105422544 ppf: 40 ppct: 5 formats: tig: atl: Derivation of a Triage Algorithm for Chest Radiography of Community-acquired Pneumonia Patients in the Emergency Department. aug: au: Kyriacou DN Yarnold PR Soltysik RC Self WH Wunderink RG Schmitt BP Parada JP Adams JG affil: Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL sug: subj: Algorithms Decision Support Techniques Pneumonia Radiography Triage Methods Adult Aged Aged, 80 and Over Case Control Studies Community-Acquired Infections Radiography Emergency Nursing Methods Female Illinois Male Middle Age Pneumonia Nursing Retrospective Design Sensitivity and Specificity Human Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: BACKGROUND: Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year. OBJECTIVES: To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP. METHODS: The authors conducted an ED-based retrospective matched case-control study using 100 radiographic confirmed CAP cases and 100 radiographic confirmed influenzalike illness (ILI) controls. Sensitivities and specificities of characteristics assessed in the triage setting were measured to discriminate CAP from ILI. The authors then used classification tree analysis to derive an algorithm that maximizes sensitivity and specificity for detecting patients with CAP in the ED triage setting. RESULTS: Temperature greater than 100.4 degrees F (likelihood ratio = 4.39, 95% confidence interval [CI] = 2.04 to 9.45), heart rate greater than 110 beats/minute (likelihood ratio = 3.59, 95% CI = 1.82 to 7.10), and pulse oximetry less than 96% (likelihood ratio = 2.36, 95% CI = 1.32 to 4.20) were the strongest predictors of CAP. However, no single characteristic was adequately sensitive and specific to accurately discriminate CAP from ILI. A three-step algorithm (using optimum cut points for elevated temperature, tachycardia, and hypoxemia on room air pulse oximetry) was derived that is 70.8% sensitive (95% CI = 60.7% to 79.7%) and 79.1% specific (95% CI = 69.3% to 86.9%). CONCLUSIONS: No single characteristic adequately discriminates CAP from ILI, but a derived clinical algorithm may detect most radiographic confirmed CAP patients in the triage setting. Prospective assessment of this algorithm will be needed to determine its effects on the care of ED patients with suspected pneumonia. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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