Wootton Dan, Feldman Charles
12Institute of Infection and Global Health, University of Liverpool, UK.
22Department of Respiratory Research, Aintree University Hospitals NHS Foundation Trust, UK.
Pneumonia (Nathan). 2014 Jun 19;5(Suppl 1):1-7. doi: 10.15172/pneu.2014.5/464. eCollection 2014.
Community-acquired pneumonia (CAP) remains a common condition associated with considerable morbidity and mortality. Outcome is improved by early recognition and rapid institution of empirical antibiotic therapy. A number of international guidelines recommend a chest radiograph (x-ray) is obtained when pneumonia is suspected; the argument forwarded is that chest radiographs are relatively inexpensive and enable pneumonia (lung consolidation) to be confirmed or excluded. But, radiographs are not available in the community setting and introduce a delay in diagnosis and treatment. For these reasons, in mild CAP treated by primary care, guidelines suggest criteria for clinical diagnosis. However, there is debate as to whether clinical features alone are sufficiently reliable to support a diagnosis of CAP with some suggesting diagnostic precision is improved by chest radiographs. Conversely, several studies have demonstrated a lack of agreement in the interpretation of chest radiographs bringing their role as the ultimate arbiter of diagnosis into question. Below we debate the diagnostic role of the humble chest radiograph in the context of suspected CAP.
社区获得性肺炎(CAP)仍然是一种常见疾病,伴有相当高的发病率和死亡率。早期识别和迅速开始经验性抗生素治疗可改善预后。一些国际指南建议,怀疑患有肺炎时应进行胸部X光检查;其理由是胸部X光检查相对便宜,能够确诊或排除肺炎(肺部实变)。但是,社区环境中无法进行X光检查,这会导致诊断和治疗延迟。出于这些原因,对于初级保健治疗的轻度CAP,指南提出了临床诊断标准。然而,对于仅凭临床特征是否足以可靠地支持CAP诊断存在争议,一些人认为胸部X光检查可提高诊断准确性。相反,多项研究表明,在胸部X光片的解读上缺乏一致性,这使得其作为诊断最终裁决者的作用受到质疑。下面我们将在疑似CAP的背景下讨论普通胸部X光片的诊断作用。
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