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¿Tiene este paciente neumonía adquirida en la comunidad? El diagnóstico de la neumonía por la historia y el examen
J P Metlay1, W N Kapoor, M J Fine
1Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
JAMA
|November 14, 1997
Resumen
El diagnóstico de la neumonía adquirida en la comunidad (CAP) en la atención ambulatoria es un desafío. Si bien ningún síntoma único confirma la CAP, la ausencia de signos vitales anormales o hallazgos de auscultación torácica puede reducir significativamente la probabilidad de neumonía.
Área de la Ciencia:
- Medicina interna es la medicina interna de las enfermedades.
- Pulmonología Pulmonología.
- Medicina de diagnóstico La medicina de diagnóstico es la medicina de diagnóstico.
Sus antecedentes:
- La neumonía adquirida en la comunidad (CAP) es una causa frecuente de síntomas respiratorios agudos en entornos ambulatorios.
- El diagnóstico preciso de la CAP es crucial para el tratamiento y el pronóstico adecuados.
- La radiografía de tórax es el estándar de oro, pero la evaluación clínica a menudo precede a la imagen.
Objetivo del estudio:
- Revisar la literatura sobre la utilidad de la historia clínica del paciente y el examen físico en el diagnóstico de CAP.
- Identificar hallazgos clínicos que ayuden a decidir si se admite o no la CAP en la atención ambulatoria.
Principales métodos:
- Revisión sistemática de los estudios publicados sobre la precisión diagnóstica de los hallazgos clínicos en la sospecha de CAP.
- Análisis de los hallazgos clínicos individuales y combinados para su capacidad de diagnosticar o excluir la neumonía.
Principales resultados:
- Ningún hallazgo clínico único o combinación confirma de manera confiable un diagnóstico de CAP.
- La ausencia de anomalías de signos vitales y los hallazgos normales de auscultación torácica disminuyen significativamente la probabilidad de CAP.
Conclusiones:
- La historia clínica y el examen físico por sí solos son insuficientes para decidir definitivamente en CAP.
- Un examen físico exhaustivo, particularmente la ausencia de signos vitales anormales y sonidos pulmonares, puede ayudar a excluir la CAP y potencialmente evitar más pruebas de diagnóstico.
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