Abstract
Aims—To understand which clinical criteria physicians use to diagnose pneumonia compared to
bronchitis and upper respiratory tract infection (URTI).
Methods—Retrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.
Results—Logistic regression analysis identified rales, a temperature ≥ 100°F (37.8°C), chest
pain, dyspnoea, rhonchi, heart rate, respiratory rate, and rhinorrhoea, as the best explanation for
the variation in diagnosis of pneumonia compared to either of the alternative diagnoses (R2
=
59.3), with rales and a temperature ≥ 100°F explaining 30% of the variation. Rales, chest pain,
and a temperature ≥ 100°F best predicted the ordering of a chest x-ray (R2
= 20.0). However, 35%
(59/175) of patients diagnosed with pneumonia had a negative chest x-ray. Abnormal breath
sounds were the best predictors for prescribing antibiotics (R2
= 38%). A significant number of
patients with acute bronchitis (93% excluding sinusitis) and URTI (42%) were given antibiotics.
Conclusions—The presence of abnormal breath sounds and a temperature ≥ 100°F were the
best predictors of a diagnosis of pneumonia.