Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report

Chest: The Journal of Circulation, Respiration and Related Systems

Adam T. Hill^1¹  Philip M. Gold^2²  Joshua P. Metlay^4³  Belinda Ireland^5⁴  Ali A. El Solh^3⁵  Richard S. Irwin^6⁶ 

[1] Department of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, Scotland^1;Loma Linda University School of Medicine, Loma Linda, CA^2;Massachusetts General Hospital and Harvard Medical School, Boston, MA^4;The EvidenceDoc, Pacific, MO^5;University at Buffalo, State University of New York, Buffalo, NY^3;University of Massachusetts Memorial Medical Center, Worcester, MA^6

关键词: cough;    evidence-based medicine;    guidelines;    influenza;    pneumonia;    CAP;    community-acquired pneumonia;    CRP;    C-reactive protein;    DART;    Documentation and Appraisal Review Tool;    GRADE;    Grading of Recommendations Assessment;    Development and Evaluation;    PICO;    patient;    intervention;    comparison;    outcome;    QUADAS;    Quality Assessment of Diagnostic Accuracy Studies;    RCT;    randomized controlled trial;    ROC;    receiver operating characteristic;   

DOI  :  10.1016/j.chest.2018.09.016

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. Methods A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. Results There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice. Conclusions For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature ≥ 38°C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.

【 授权许可】

CC BY