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- Title
Pneumonia recovery: discrepancies in perspectives of the radiologist, physician and patient.
- Authors
Bruns, Anke H. W.; Oosterheert, Jan Jelrik; El Moussaoui, Rachida; Opmeer, Brent C.; Hoepelman, Andy I. M.; Prins, Jan M.
- Abstract
<bold>Background: </bold>Chest radiographs are often used to diagnose community-acquired pneumonia (CAP), to monitor response to treatment and to ensure complete resolution of pneumonia. However, radiological exams may not reflect the actual clinical condition of the patient.<bold>Objective: </bold>To compare the radiographic resolution of mild to moderately severe CAP to resolution of clinical symptoms as assessed by the physician or rated by the patient.<bold>Design: </bold>Prospective cohort study.<bold>Participants: </bold>One hundred nineteen patients admitted because of mild to moderately severe CAP with new pulmonary opacities.<bold>Main Measures: </bold>Radiographic resolution and clinical cure of CAP were determined at day 10 and 28. Radiographic resolution was defined as the absence of infection-related abnormalities; clinical cure was rated by the physician and defined by improvement of signs and symptoms. In addition, the CAP score, a patient-based symptom score, was calculated.<bold>Key Results: </bold>Radiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3-16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure.<bold>Conclusions: </bold>In mild to moderately severe CAP, resolution of radiographic abnormalities and resolution of symptoms scored by the patient lag behind clinical cure assessed by physicians. Monitoring a favorable disease process by routine follow-up chest radiographs seems to have no additional value above following a patient's clinical course.
- Subjects
RADIOGRAPHY; PNEUMONIA; PNEUMONIA Severity Index; LUNG disease treatment; SYMPTOMS; PHYSICIANS; PATIENT participation; COMPARATIVE studies; CONVALESCENCE; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MEDICAL specialties &; specialists; PSYCHOLOGY of physicians; RESEARCH; EVALUATION research; COMMUNITY-acquired infections; PSYCHOLOGY
- Publication
JGIM: Journal of General Internal Medicine, 2010, Vol 25, Issue 3, p203
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-009-1182-7