section name header

Evidence summaries

Diagnosis of Pneumonia by History and Physical Examination

No individual clinical findings or combinations of findings appear to be sufficient for ruling in the diagnosis of pneumonia. If diagnostic certainty is required, chest radiography should be performed. Level of evidence: "B"

A systematic review 1 including 4 high-quality studies was abstracted in DARE. Likelihood ratios were calculated for the presence or absence of individual clinical findings.

Accuracy of clinical history: prevalence of pneumonia ranged from 2.6% to 38.3%. No single item in the clinical history raised the odds of pneumonia high enough to confirm a diagnosis without a chest radiograph.

Accuracy of physical examination: likelihood ratios for the presence of any individual vital sign abnormality ranged from 2 to 4, and varying the cut off point for the abnormalities did not have a substantial impact on the LRs. The LRs for the absence of any vital sign abnormality (LR-) was 0.5 to 0.8.

References

Primary/Secondary Keywords