• Jennifer Evertsen, Dennis J Baumgardner, Ann Regnery, and Indrani Banerjee.
• University of Wisconsin School of Medicine and Public Health, Milwaukee, WI 53233, USA. evertsen@wisc.edu
• Prim Care Respir J. 2010 Sep 1; 19 (3): 237-41.

AimsTo understand which clinical criteria physicians use to diagnose pneumonia compared to bronchitis and upper respiratory tract infection (URTI).MethodsRetrospective chart review of adults diagnosed with pneumonia, bronchitis, or URTI.ResultsLogistic regression analysis identified rales, a temperature > 100 degrees F (37.8 degrees 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 degrees F explaining 30% of the variation. Rales, chest pain, and a temperature > 100 degrees 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.ConclusionsThe presence of abnormal breath sounds and a temperature > 100 degrees F were the best predictors of a diagnosis of pneumonia.

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