Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings


Bektas F., SÖYÜNCÜ S., YİĞİT Ö., Arslan G.

TURKIYE KLINIKLERI TIP BILIMLERI DERGISI, cilt.32, sa.4, ss.971-978, 2012 (SCI-Expanded) identifier identifier

  • 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.