Authors: Graffelman, A Willy¹; Willemssen, Francois EJA²; Zonderland, Harmine M³; Knuistingh Neven, Arie¹; Kroes, Aloys CM⁴; van den Broek, Peterhans J⁵

Source: British Journal of General Practice, Volume 58, Number 547, February 2008 , pp. 93-97(5)

Publisher: Royal College of General Practitioners

Abstract:

Background:

In patients with lower respiratory tract infection (LRTI), changes on chest radiography are rare but poorly characterised, especially in general practice.

Aim:

To describe the range of findings on chest radiographs and the associations between these findings and the aetiology of LRTI.

Design of study:

A prospective observational study.

Setting:

General practices in the Leiden region, The Netherlands.

Method:

Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood, and throat swabs were collected for diagnostic tests. Chest X-ray findings were assessed in relation to the aetiology.

Results:

An abnormality on the chest X-ray was observed in 72 (55%) patients. Forty-five patients (35%) had changes due to infection, and 26 (20%) due to pneumonia. Pathogens were detected in 84 patients (33 single bacterial, 43 single viral, and 8 dual). Twelve (29%) patients with a bacterial infection (including dual infections) compared to four (9%) patients with viral infection had pneumonia on the chest X-ray (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2 to 13.8). Using the presence of pneumonia on chest X-ray as a test to predict a bacterial infection, the positive predictive value and the negative predictive value were 75% (CI = 48 to 93%) and 57% (CI = 45 to 69%), respectively.

Conclusion:

Pneumonia on the chest X-ray was found more frequently in patients with a bacterial infection than in patients with a viral infection. However, the sensitivity and the specificity are such that pneumonia on the chest X-ray is not a reliable test to discriminate between bacterial and non-bacterial LRTI in the general practice setting.

References: 12 references open in new window

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Keywords: adult; etiology; primary health care; radiography, thoracic; respiratory tract infections

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp08X264054

Affiliations: 1: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands 2: Department of Radiology, Erasmus MC, Rotterdam, The Netherlands 3: Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 4: Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands 5: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands

Publication date: 2008-02-01

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• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.

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