Hospital Tuanku Ja'afar, Medical Department, Seremban, Ministry of Health Malaysia.
Hospital Tuanku Ja'afar, Radiological Department, Seremban, Ministry of Health Malaysia.
Med J Malaysia. 2020 Jan;75(1):7-11.
The primary objective of this study was to describe the accuracy of pneumonia diagnosis, both community-acquired pneumonia (CAP) and hospitalacquired pneumonia (HAP). Secondary objectives were describing the choice of antibiotics used, pathogens isolated, and predictive parameters in diagnosing pneumonia.
This was a prospective cross-sectional study to determine the accuracy of the diagnosis of CAP and HAP admitted to Hospital Tuanku Ja'afar. All patients aged ≥12 years admitted to the general medical ward with the diagnosis of CAP or HAP were included in the study. Chest radiograph interpretation was done by certified radiologists. An accurate diagnosis of pneumonia was defined by clinical signs and symptoms of pneumonia supported by radiographical evidence.
A total of 159 patients were enrolled into the study from January 2018 to February 2018. Of these only 59(37.1%) cases were accurately diagnosed as pneumonia. Amongst those with pneumonia diagnosis made by the emergency department, medical officers and specialists of medical department; 65.4%, 60% and 47.3% respectively were not pneumonia. Amoxicillin with clavulanate and azithromycin were amongst the most common first choice of antibiotic used (46.5%). In this study, pathogens were isolated either by blood culture or sputum culture in only 20 (12.6%) patients. There was no significant predictive parameter identified in this study, which included white cell counts, Creactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and Pao2/FiO2 ratio.
About two-thirds of patients diagnosed with pneumonia did not have a compatible radiological finding. Better tools and systems are needed to aid in the diagnosis of pneumonia.
本研究的主要目的是描述社区获得性肺炎（CAP）和医院获得性肺炎（HAP）的诊断准确性。次要目的是描述所使用的抗生素选择、分离的病原体以及诊断肺炎的预测参数。
这是一项前瞻性横断面研究，旨在确定 Tuanku Ja'afar 医院收治的 CAP 和 HAP 患者的诊断准确性。所有年龄≥12 岁、因 CAP 或 HAP 被收入普通内科病房的患者均纳入本研究。胸部 X 线片的解读由认证放射科医生进行。肺炎的准确诊断定义为临床症状和体征支持放射学证据的肺炎。
2018 年 1 月至 2 月期间，共有 159 例患者纳入本研究。其中只有 59 例（37.1%）患者被准确诊断为肺炎。在急诊科、医疗官员和内科专家做出肺炎诊断的患者中，分别有 65.4%、60%和 47.3%实际上并非肺炎。阿莫西林克拉维酸和阿奇霉素是最常用的一线抗生素（46.5%）。在本研究中，只有 20 例（12.6%）患者通过血培养或痰培养分离出病原体。本研究未发现有意义的预测参数，包括白细胞计数、C 反应蛋白（CRP）水平、红细胞沉降率（ESR）和 Pao2/FiO2 比值。
约三分之二诊断为肺炎的患者没有影像学检查结果支持。需要更好的工具和系统来辅助肺炎的诊断。
