From the Guidelines
A pneumonia workup is a comprehensive diagnostic process that typically includes physical examination, chest X-ray, blood tests, pulse oximetry, and sometimes sputum culture, urine antigen tests, and nasopharyngeal swab, with the goal of confirming pneumonia and determining its cause to guide appropriate treatment. The workup for pneumonia should prioritize the most recent and highest quality evidence, which suggests that a combination of clinical symptoms and signs, such as cough, dyspnea, pleural pain, sweating/fevers/shivers, aches and pains, temperature 38C or greater, tachypnea, and new and localizing chest examination signs, can be suggestive of pneumonia 1. The use of C-reactive protein (CRP) can also strengthen both the diagnosis and exclusion of pneumonia, with a CRP of 30 mg/L or higher increasing the likelihood of pneumonia in the presence of suggestive symptoms and signs 1. The following components are typically included in a pneumonia workup:
- Physical examination: Listening to lung sounds and checking vital signs
- Chest X-ray: To visualize lung infiltrates or consolidation
- Blood tests: Complete blood count (CBC) to check for elevated white blood cells, and blood cultures to identify potential pathogens
- Pulse oximetry: To measure blood oxygen levels
- Additional tests may include sputum culture, urine antigen tests, and nasopharyngeal swab, depending on the clinical presentation and suspected cause of pneumonia It is essential to note that the specific components of the workup may vary depending on the patient's presentation, underlying health status, and local epidemiology, and that the workup should be guided by the most recent and highest quality evidence, such as the 2019 guidelines for adult outpatients with acute cough due to suspected pneumonia or influenza 1. The goal of the workup is to guide appropriate treatment, which usually involves antibiotics such as azithromycin or amoxicillin for typical community-acquired pneumonia, with the specific antibiotic choice depending on the suspected pathogen, patient factors, and local resistance patterns 1. Prompt and thorough evaluation is crucial as pneumonia can be life-threatening, especially in elderly or immunocompromised patients, and the workup allows for targeted therapy, reducing antibiotic resistance and improving patient outcomes.
From the Research
Pneumonia Workup
A pneumonia workup typically involves a combination of history, physical examination, imaging, and laboratory assessment to diagnose and manage community-acquired pneumonia. The following are key components of a pneumonia workup:
- History: A patient's history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline is suggestive of pneumonia 2
- Physical examination: Abnormal vital signs (e.g., fever, tachycardia) and lung examination findings are important in diagnosing pneumonia 2
- Imaging: Chest radiography or ultrasonography can confirm the diagnosis of pneumonia 2
- Laboratory assessment: Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy, and biomarkers such as procalcitonin can assist with risk stratification 2
Diagnostic Challenges
Diagnosing pneumonia can be challenging due to the broad range of clinical presentations and potential life-threatening nature of the illness. The following are some diagnostic challenges:
- The absence of individual clinical findings or combinations of findings that can rule in the diagnosis of pneumonia 3
- The limitations of chest radiography, which is considered the gold standard for pneumonia diagnosis, but has unknown sensitivity and specificity 4
- The need for expert opinion in seeking strategies to optimize the balance between harms and benefits of ordering a chest radiograph 4
Risk Stratification
Risk stratification is important in determining the optimal treatment strategy for patients with community-acquired pneumonia. The following are some factors that can help estimate the short-term risk for death: