Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings
TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, cilt.32, sa.4, ss.971-978, 2012 (SCI-Expanded)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 32 Sayı: 4
- Basım Tarihi: 2012
- Doi Numarası: 10.5336/medsci.2011-25652
- Dergi Adı: TURKIYE KLINIKLERI TIP BILIMLERI DERGISI
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.971-978
- Anahtar Kelimeler: Transplantation, pneumonia, emergency medicine, decision making, COMMUNITY-ACQUIRED PNEUMONIA, MANAGEMENT, RECIPIENTS, ADULTS
- Akdeniz Üniversitesi Adresli: Evet
Özet
Objective: The aim of the study is to determine the diagnostic accuracy of emergency physician judgment for diagnosis of pneumonia in transplant patients with fever in emergency settings. Material and Methods: This prospective, convenience sample study was performed in a tertiary care university emergency department. All solid organ transplant patients presenting to the emergency department with fever as a chief complaint, between 08:00 and 24:00 hours were enrolled into the study. Before performing chest X-ray, according to the clinical findings of pneumonia, emergency physician need to assign a pre-chest X-ray level of certainty for pneumonia using a visual analog scale from 0 mm to 100 mm, with 100 mm being the most certain. The chest X-ray reports were classified into three groups: Normal, pneumonia (having pulmonary infiltrates diagnostic and suggestive of pneumonia) and abnormal but not pneumonia. Results: Of the 77 study patients, 10 (13%) patients were diagnosed as pneumonia. Sensitivity, specificity and positive and negative likelihood ratio of the judgment of emergency physician in diagnosing pneumonia in our patients population were 70% [95% confidence interval (CI): 35-91], 94% (95% CI: 84-98), 11.7 (95% CI: 4.1-32.9) and 0.31 (95% CI: 0.12-0.82), respectively. Conclusion: In the presence of clinical signs of pneumonia, diagnostic accuracy of emergency physician judgment was high for diagnosis of pneumonia in transplant patients with fever in emergency settings.