DOES THIS PATIENT HAVE COMMUNITY-ACQUIRED PNEUMONIA - DIAGNOSING PNEUMONIA BY HISTORY AND PHYSICAL-EXAMINATION

Community-acquired pneumonia is an important cause of acute respirator y symptoms (eg, cough) in the ambulatory care setting, Distinguishing pneumonia from other causes of respiratory illnesses, such as acute br onchitis and upper respiratory tract infections, has important therape utic and prognostic implications, The reference standard for diagnosin g pneumonia is chest radiography, but it is likely that many physician s rely on the patient's history and their physical examination to diag nose or exclude this disease. A review of published studies of patient s suspected of having pneumonia reveals that there are no individual c linical findings, or combinations of findings, that can rule in the di agnosis of pneumonia for a patient suspected of having this illness, H owever, some studies have shown that the absence of any vital sign abn ormalities or any abnormalities on chest auscultation substantially re duces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary, This article reviews the literature on the appropriate use of the history and physical examination in diagnos ing community-acquired pneumonia.