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Diagnostic value of signs, symptoms and laboratory values in lower respiratory tract infection

Stolz, D. and Christ-Crain, M. and Gencay, M. M. and Bingisser, R. and Huber, P. R. and Muller, B. and Tamm, M.. (2006) Diagnostic value of signs, symptoms and laboratory values in lower respiratory tract infection. Swiss Medical Weekly, 136 (27-28). pp. 434-440.

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Official URL: http://edoc.unibas.ch/56919/

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Abstract

BACKGROUND: Lower respiratory tract infections (LRTI) account for the majority of all antibiotics prescribed in the clinical practice, irrespective of the fact that most cases are self-limiting. Using the outcome and microbiology findings as gold standard, we determined sensitivity, specificity, positive and negative predictive values of common used signs and symptoms of bacterial LRTI requiring antibiotic therapy. PATIENTS: 243 consecutive patients with suspected LRTI admitted to a tertiary care hospital. RESULTS: Bacterial LRTI requiring antibiotic therapy and self-limiting LRTI were diagnosed in 32 and 86 patients, respectively. Assessing these two groups, sputum, dyspnea, crackles, fever and leukocytes (WBC) were insensitive and unspecific parameters for the diagnosis of bacterial LRTI requiring antibiotic therapy. Cough was sensitive (93.8%) but unspecific (5.8%). The sensitivity of infiltrates, C-reactive protein (CRP) <50 mg/L and procalcitonin (PCT) <0.1 ng/mL was 96.9%, 93.8% and 93.8%, respectively. PCT <0.25 ng/mL showed the highest specificity (97.7%), followed by WBC <16 x 109/L (94.2%) and CRP <100 mg/L (91.9%). The sensitivity of WBC <16 x 109/L was low (37.5%). CONCLUSION: The overall sensitivity and specificity of signs and symptoms for bacterial LRTI requiring antibiotic therapy was poor. Obtaining a chest-X-ray with infiltrates and determining CRP at a cut-off value of 50 mg/L or PCT at a cutoff value of 0.1 ng/mL was required to ascertain the need for antibiotics in LRTI.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Allgemeine innere Medizin AG > Argovia Professur für Medizin (Müller)
UniBasel Contributors:Müller, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:EMH Schweizerischer Arzteverlag
ISSN:1424-7860
e-ISSN:1424-3997
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:27 Nov 2017 10:44
Deposited On:27 Nov 2017 10:44

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