Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness.

The Center for Health Equity Research and Promotion, VA Medical Center and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.

PURPOSE: This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. METHODS: A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. RESULTS: Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. CONCLUSIONS: Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.

PMID: 17606087 [PubMed - indexed for MEDLINE]