Predicting Pneumococcal Community-Acquired Pneumonia in the Emergency Department Evaluation of clinical parameters.
Clin Microbiol Infect. 2014 Jun 30;
Authors: Huijts SM, Boersma WG, Grobbee DE, Gruber WC, Jansen KU, Kluytmans JA, Kuipers BA, Palmen F, Pride MW, Webber C, Bonten MJ, The CAP Diagnostics investigators
OBJECTIVE: To quantify the value of clinical predictors available in the emergency department (ED) in predicting Streptococcus pneumoniae as cause of community acquired pneumonia (CAP).
METHODS: Prospective, observational, cohort study of patients with CAP presenting in the ED. Pneumococcal aetiology of CAP was based on either bacteraemia, or S. pneumoniae cultured from sputum, or urinary immunochromatographic assay (ICA) positivity or positivity of a novel serotype specific urinary antigen detection (UAD). Multivariate logistic regression was used to identify independent predictors and various cut-off values of probability scores were used to evaluate the usefulness of the model.
RESULTS: 328 patients (31.0%) of 1,057 patients with CAP had pneumococcal CAP. Nine independent predictors for pneumococcal pneumonia were identified, but the clinical utility of this prediction model was disappointing because of low positive predictive values or a small yield.
CONCLUSION: Clinical criteria have insufficient diagnostic capacity to predict pneumococcal CAP. Rapid antigen detecting tests are needed to diagnose S. pneumoniae at the time of hospital admission. This article is protected by copyright. All rights reserved.
PMID: 24975428 [PubMed - as supplied by publisher]