‘Urgent need’ for primary care pneumonia diagnosis tools

While family doctors can exclude pneumonia with a high level of accuracy, they can only identify around a third of radiographically confirmed cases, research shows.

"The results of the study are encouraging to some extent as the findings might support physicians to rely more on their ability to correctly exclude pneumonia which might result in better targeted antibiotic prescriptions," said author Saskia van Vugt (Utrecht Julius Center for Health Sciences and Primary Care, the Netherlands) in a press statement.

"However, a majority of the pneumonia cases in this study were not picked up by an initial assessment alone."

The study, reported in the European Respiratory Journal, included 2810 patients, from 12 European countries, presenting to their general practitioner (GP) with acute cough or suspected lower respiratory tract infection. GPs made a yes/no diagnosis of pneumonia, and all patients underwent chest radiography within a week.

Overall, 140 (5%) patients had radiographic pneumonia and 72 (3%) were judged to have pneumonia by their GP.

GPs diagnosed 29% of pneumonia cases that were later confirmed by radiography. Conversely, an inaccurate pneumonia diagnosis was made by GPs in just 1% of the 2670 patients who did not have radiographic pneumonia.

The negative predictive value showed that GPs could accurately exclude pneumonia in 96% of cases. This should give GPs confidence in withholding antibiotic treatment, say the authors, who explain that GPs are often reluctant to do so for fear of missing pneumonia cases.

However, the finding that GPs could not diagnose the majority of radiographic pneumonia cases shows that further tools are needed to improve pneumonia detection in primary care.

"Tests that could support a doctor's ability to detect or exclude pneumonia are urgently needed. We should also remember that GPs tell patients to revisit them if symptoms get worse or persist, as a 'safety net' for initially missed cases," van Vugt concludes.

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