Emergency Medicine

Adults who arrive at the emergency department with acute cough and vital sign abnormalities may have pneumonia

Only a small group of adults who arrive at the hospital emergency department (ED) with acute cough will have community-acquired pneumonia (CAP). These are individuals who have vital sign abnormalities along with their cough, according to a new study. Ralph Gonzales, M.D., M.S.P.H., of the University of California, San Francisco, and colleagues examined a random sample of adult visits for acute cough to 15 Veterans Administration (VA) and non-VA EDs during 2 winters.

Of the 4,464 patient medical charts reviewed, 421 had a diagnosis of CAP. Age greater than 50 years and vital sign abnormality were the only significant predictors of CAP. Vital sign abnormalities included fever, low blood-oxygen levels (hypoxemia), rapid heart beat (tachycardia), and tachypnea (rapid breathing). Hypoxemia increased 3.5 times the likelihood of CAP diagnosis. A greater number of vital sign abnormalities were associated with a higher prevalence of CAP, from 12 percent with one abnormality to 69 percent with four vital-sign abnormalities. Most vital sign abnormalities were predictive of CAP regardless of patient age.

These results are consistent with previous studies. They also support the recommendation to order a chest x-ray to evaluate possible CAP in adults who arrive at the ED with acute cough and vital sign abnormalities and/or advanced age. The predictive value of abnormal vital signs was not diminished in elderly patients.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13915).

See "Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness," by Brendon R. Nolt, M.D., Dr. Gonzales, Judy Maselli, M.S.P.H., and others, in the July 2007 American Journal of Emergency Medicine 25, pp. 631-636.

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