Acute cough illness in general practice - predictive value of clinical judgement and accuracy of requesting chest x-rays.

The aim of the study was to evaluate the accuracy of GPs' initial clinical judgement regarding presence or absence of pneumonia and to assess GPs' strategy for requesting chest X-rays in patients presenting with acute cough. GPs were asked to rate their suspicion of pneumonia based on clinical assessment alone and to protocol their decision to perform chest X-rays in 212 consecutive patients. These judgements were compared to the final diagnosis as determined by chest X-ray or uneventful recovery (four weeks). After history taking and physical examination, GPs are highly accurate in judging which patients presenting with acute cough may have pneumonia (PPV 80% [95% CI 0,66-0,89]) or not (NPV 100% [95% CI 0,97-1,0]), and in which patients chest X-rays are required or not (spearman's rho 0,54, p<0,0001).