Metlay J P, Kapoor W N, Fine M J
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
JAMA. 1997 Nov 5;278(17):1440-5.
Community-acquired pneumonia is an important cause of acute respiratory symptoms (eg, cough) in the ambulatory care setting. Distinguishing pneumonia from other causes of respiratory illnesses, such as acute bronchitis and upper respiratory tract infections, has important therapeutic and prognostic implications. The reference standard for diagnosing pneumonia is chest radiography, but it is likely that many physicians rely on the patient's history and their physical examination to diagnose or exclude this disease. A review of published studies of patients suspected of having pneumonia reveals that there are no individual clinical findings, or combinations of findings, that can rule in the diagnosis of pneumonia for a patient suspected of having this illness. However, some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary. This article reviews the literature on the appropriate use of the history and physical examination in diagnosing community-acquired pneumonia.
社区获得性肺炎是门诊医疗环境中急性呼吸道症状（如咳嗽）的重要病因。将肺炎与其他呼吸道疾病病因（如急性支气管炎和上呼吸道感染）区分开来具有重要的治疗和预后意义。诊断肺炎的参考标准是胸部X光检查，但许多医生可能依靠患者的病史和体格检查来诊断或排除这种疾病。对已发表的疑似肺炎患者研究的综述表明，没有任何单独的临床发现或发现组合能够确诊疑似患有该疾病的患者为肺炎。然而，一些研究表明，没有任何生命体征异常或胸部听诊异常可将肺炎的可能性大幅降低到无需进一步诊断评估的程度。本文综述了有关在诊断社区获得性肺炎时合理使用病史和体格检查的文献。
