Brander Patrick, Garin Nicolas
Service de médecine interne générale, HUG, 1211 Genève 14.
Rev Med Suisse. 2011 Oct 19;7(313):2026-9.
Pneumonia is a frequent concern in the ambulatory setting. Diagnosis should be prompt, as delays in the instauration of the treatment are associated with a worse prognosis. However, empiric antibiotic treatment of all patients suspected of having pneumonia is unwarranted, and can affect adversely bacterial ecology. Chest X-ray remains the gold standard, and should always be obtained to confirm the diagnosis, as clinical findings are non-specific. Conversely, some clinical findings can be used to rule out pneumonia with sufficient negative predictive value in a low-prevalence setting. A chest X-ray can be omitted for these patients. We aimed to point which symptoms and signs are useful in assessing the clinical probability of pneumonia, and review clinical rules proposed for this purpose.
肺炎是门诊环境中常见的问题。诊断应迅速，因为治疗开始延迟与预后较差有关。然而，对所有疑似肺炎的患者进行经验性抗生素治疗是不必要的，且会对细菌生态产生不利影响。胸部X光仍然是金标准，应始终进行以确诊，因为临床表现不具特异性。相反，在低患病率环境中，一些临床表现可用于以足够的阴性预测值排除肺炎。对于这些患者可省略胸部X光检查。我们旨在指出哪些症状和体征有助于评估肺炎的临床可能性，并综述为此目的提出的临床规则。
