Titre
Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Fischer, C.
Auteure/Auteur
Knüsli, J.
Auteure/Auteur
Lhopitallier, L.
Auteure/Auteur
Tenisch, E.
Auteure/Auteur
Meuwly, M.G.
Auteure/Auteur
Douek, P.
Auteure/Auteur
Meuwly, J.Y.
Auteure/Auteur
D'Acremont, V.
Auteure/Auteur
Kronenberg, A.
Auteure/Auteur
Locatelli, I.
Auteure/Auteur
Mueller, Y.
Auteure/Auteur
Senn, N.
Auteure/Auteur
Boillat-Blanco, N.
Auteure/Auteur
Liens vers les unités
ISSN
2079-6382
Statut éditorial
Publié
Date de publication
2023-03-02
Volume
12
Numéro
3
Première page
496
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR-) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR- of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR- (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs.
PID Serval
serval:BIB_EA5C7FEC948C
PMID
Open Access
Oui
Date de création
2023-04-03T09:42:14.974Z
Date de création dans IRIS
2025-05-21T06:57:31Z
Fichier(s)![Vignette d'image]()
En cours de chargement...
Nom
antibiotics-12-00496.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
Taille
289.96 KB
Format
Adobe PDF
PID Serval
serval:BIB_EA5C7FEC948C.P001
URN
urn:nbn:ch:serval-BIB_EA5C7FEC948C6
Somme de contrôle
(MD5):bb7645c5195ad9cfd51202c323cd4d3b