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26-03-2013 | Infectious disease | Article

Electronic tool helps doctors identify pneumonia patients


Free abstract

medwireNews: US researchers have developed a real-time electronic screening tool to help emergency department physicians identify patients with pneumonia.

"The tool provides a way of more quickly and accurately identifying pneumonia patients in the emergency department, which alerts doctors to use the second part of the tool that provides guidance for treatment," commented study author Nathan Dean (University of Utah School of Medicine, Salt Lake City) in a press statement.

"We hope that through earlier, and perhaps more accurate, diagnosis of pneumonia patients, along with alerting and guiding physicians to use the treatment guidance tool, patient outcomes will be improved," he said.

As reported in JAMA Internal Medicine, the team developed the tool based on reference data collected from 48,449 patients, 2413 with pneumonia, who attended the emergency department at Intermountain Medical Center between 2008 and 2010. Dean and co-workers used 12 vital sign and laboratory values, 25 nursing assessment variables, as well as patient age, chief medical complaint, and the patient's chest imaging report to estimate risk for pneumonia.

The accuracy of the tool was tested during a 2-month period on 721 emergency department patients. Physician panel review diagnosed pneumonia in 109 patients during this time. The diagnostic tool agreed with the positive physician diagnosis in 81 (74%) of the patients and the false-positive rate generated by the tool was 13%.

Dean and co-authors calculated that the sensitivity and specificity of the tool were 40.9% and 96.6%, respectively, and positive and negative predictive values were a respective 50.9% and 95.0%.

The researchers found that most (59%) of the false-positive cases generated by the tool were caused by incorrectly read imaging reports; a lack of clinical features other than chest imaging was responsible for the majority of false-negative cases.

"Our goal is to have the tool standardize what we do to ensure that we are all doing the same things consistently for all patients," co-author Caroline Vines, Intermountain Medical Center, Murray, Utah, told the press. "The best thing about the tool is that it's easy to use and reminds you to order the appropriate tests and proper antibiotics for the patient."

The authors concede that the test is in early stages of development, but say that "accuracy and utilization will likely improve with iterative improvements.

"The next performance test will be to determine if the tool helps physicians diagnose pneumonia and improve clinical outcomes."

By Helen Albert, Senior medwireNews Reporter

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