Accuracy of physician judgment for diagnosis of pneumonia in transplant patients with fever in emergency settings

Abstract

Objective: The aim of the study is to determine the diagnostic accuracy of emergency physician judgment for diagnosis of pneumonia in transplant patients with fever in emergency set-tings. Material and Methods: This prospective, convenience sample study was performed in a tertiary care university emergency department. All solid organ transplant patients presenting to the emergency department with fever as a chief complaint, between 08:00 and 24:00 hours were enrolled into the study. Before performing chest X-ray, according to the clinical findings of pneumonia, emergency physician need to assign a prechest X-ray level of certainty for pneumonia using a visual analog scale from 0 mm to 100 mm, with 100 mm being the most certain. The chest X-ray reports were classified into three groups: Normal, pneumonia (having pulmonary infiltrates diagnostic and suggestive of pneumonia) and abnormal but not pneumonia. Results: Of the 77 study patients, 10 (13%) patients were diagnosed as pneumonia. Sensitivity, specificity and positive and negative likelihood ratio of the judgment of emergency physician in diagnosing pneumonia in our patients population were 70% [95% confidence interval (CI): 35-91], 94% (95% CI: 84-98), 11.7 (95% CI: 4.1-32.9) and 0.31 (95% CI: 0.12-0.82), respectively. Conclusion: In the presence of clinical signs of pneumonia, diagnostic accuracy of emergency physician judgment was high for diagnosis of pneumonia in transplant patients with fever in emergency settings. © 2012 by Türkiye Klinikleri.