Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
BMJ Open. 2024 May 30;14(5):e079123. doi: 10.1136/bmjopen-2023-079123.
This study aimed to describe the clinical characteristics of adults with suspected acute community-acquired pneumonia (CAP) on hospitalisation, evaluate their prediction performance for CAP and compare the performance of the model to the initial assessment of the physician.
Cross-sectional, multicentre study.
The data originated from the INfectious DisEases in Emergency Departments study and were collected prospectively from patient interviews and medical records. The study included four Danish medical emergency departments (EDs) and was conducted between 1 March 2021 and 28 February 2022.
A total of 954 patients admitted with suspected infection were included in the study.
The primary outcome was CAP diagnosis assessed by an expert panel.
According to expert evaluation, CAP had a 28% prevalence. 13 diagnostic predictors were identified using least absolute shrinkage and selection operator regression to build the prediction model: dyspnoea, expectoration, cough, common cold, malaise, chest pain, respiratory rate (>20 breaths/min), oxygen saturation (<96%), abnormal chest auscultation, leucocytes (<3.5×10/L or >8.8×10/L) and neutrophils (>7.5×10/L). C reactive protein (<20 mg/L) and having no previous event of CAP contributed negatively to the final model. The predictors yielded good prediction performance for CAP with an area under the receiver-operator characteristic curve (AUC) of 0.85 (CI 0.77 to 0.92). However, the initial diagnosis made by the ED physician performed better, with an AUC of 0.86 (CI 84% to 89%).
Typical respiratory symptoms combined with abnormal vital signs and elevated infection biomarkers were predictors for CAP on admission to an ED. The clinical value of the prediction model is questionable in our setting as it does not outperform the clinician's assessment. Further studies that add novel diagnostic tools and use imaging or serological markers are needed to improve a model that would help diagnose CAP in an ED setting more accurately.
NCT04681963.
本研究旨在描述住院成人疑似急性社区获得性肺炎（CAP）的临床特征，评估其对 CAP 的预测性能，并比较该模型与医师初始评估的表现。
横断面、多中心研究。
该数据源自传染病急症科研究，通过患者访谈和病历记录进行前瞻性收集。研究包括丹麦的四个医疗急救部门（EDs），于 2021 年 3 月 1 日至 2022 年 2 月 28 日进行。
共纳入 954 名因疑似感染住院的患者。
主要结局是由专家组评估的 CAP 诊断。
根据专家评估，CAP 的患病率为 28%。使用最小绝对收缩和选择算子回归识别出 13 个诊断预测因子来构建预测模型：呼吸困难、咳痰、咳嗽、普通感冒、不适、胸痛、呼吸频率（>20 次/分钟）、血氧饱和度（<96%）、异常胸部听诊、白细胞（<3.5×10/L 或>8.8×10/L）和中性粒细胞（>7.5×10/L）。C 反应蛋白（<20mg/L）和无 CAP 既往发作对最终模型有负面影响。该预测因子对 CAP 具有良好的预测性能，受试者工作特征曲线下面积（AUC）为 0.85（95%CI 0.77 至 0.92）。然而，ED 医师做出的初始诊断表现更好，AUC 为 0.86（95%CI 84% 至 89%）。
典型的呼吸道症状，加上异常的生命体征和升高的感染生物标志物，是 ED 住院患者发生 CAP 的预测因子。在我们的环境中，该预测模型的临床价值值得怀疑，因为它并不优于临床医生的评估。需要进一步的研究，增加新的诊断工具，并使用影像学或血清学标志物，以改进一个更准确地诊断 ED 中 CAP 的模型。
NCT04681963。
