Download PDF
Dtsch Med Wochenschr 2001; 126(48): 1373-1378
DOI: 10.1055/s-2001-18657
Übersichten
© Georg Thieme Verlag Stuttgart · New York

Pneumoniediagnose in der Praxis auf dem Prüfstand: Wie viel Diagnostik ist erforderlich?

The diagnosis of pneumonia in daily practice: how many diagnostic measures are essential?S. Ewig1 , H. Magnussen2
  • 1Medizinische Poliklinik der Universität Bonn (Direktor: Prof. Dr.med. H.Vetter)
  • 2Zentrum für Pneumologie und Thoraxchirurgie (Ärztlicher Direktor: Prof. Dr. med. H. Magnussen), Krankenhaus Grosshansdorf
Further Information

Publication History

Publication Date:
29 November 2001 (online)

Also available at
    Permissions and Reprints

Die Diagnosestellung einer ambulant erworbenen Pneumonie (AEP) bereitet im Krankenhaus in der Regel keine Probleme. Anders sieht die Situation im ambulanten Bereich aus. Hier gehören - insbesonders in den Herbst- und Wintermonaten - Infektionen der unteren Atemwege zu den häufigsten Erkrankungen überhaupt. Der Arzt sieht sich hier vor die Aufgabe gestellt, auf der Grundlage klinischer Kriterien Pneumonien von unteren Atemwegsinfektionen zu unterscheiden. Die wichtigste Methode für die Diagnosestellung einer Pneumonie, das Röntgen-Thoraxbild, steht häufig nicht ohne weiteren Aufwand zur Verfügung. Laborwerte, Blutgasanalysen oder mikrobiologische Untersuchungen (zum Beispiel Gramfärbung und Kultur des Sputums) sind differentialdiagnostisch in der Regel wenig hilfreich. Welches ist in dieser Situation die angemessene diagnostische Strategie?

Literatur

  • 1 American Thoracic Society . Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, initial antimicrobial therapy, and prevention.  Am J Respir Crit Care Med. 2001;  163 1730-1754
    Google Scholar
  • 2 Berntsson E, Lagerfeld T, Strannegard Ö, Trollfors B. Etiology pf community-acquired pneumonia in out-patients.  Eur J Clin Microbiol. 1985;  5 446-447
    Google Scholar
  • 3 Deutsche Gesellschaft für Pneumologie . Empfehlungen zur Diagnostik der ambulant erworbenen Pneumonie.  Pneumologie. 1997;  51 69-77
    Google Scholar
  • 4 Diehr P, Wood R W, Bushyhead J, Krueger L, Wolcott B, Tompkins R K. Prediction of pneumonia in outpatients with acute cough: a statistical approach.  J Chronic Dis. 1984;  37 215-225
    Google Scholar
  • 5 Emerman C L, Dawson N, Speroff T. et al . Comparison of physician judgment and decision aids for ordering chest radiographs for pneumonia in outpatients.  Ann Emerg Med. 1991;  20 1215-1219
    Google Scholar
  • 6 Emerman C L, Cydulka R K. Evaluation of high yield criteria for chest radiography in acute exacerbations of chronic obstructive pulmonary disease.  Ann Emerg Med. 1993;  22 680-684
    Google Scholar
  • 7 European Study on Community-acquired pneumonia (ESOCAP) Commitee . Guidelines for management of adult community-acquired lower respiratory tract infections.  Eur Respir J. 1998;  11 986-991
    Google Scholar
  • 8 Ewig S. Community-acquired pneumonia: epidemiology, risk, and prognosis.  Eur Respir Mon. 1996;  2 13-35
    Google Scholar
  • 9 Ewig S. Community-acquired pneumonia: definition, epidemiology, and outcome.  Semin Respir Infect. 1999;  14 94-102
    Google Scholar
  • 10 Ewig S, Soler N, Torres A. Chronic obstructive pulmonary disease (COPD) and infection: from stable patients to pneumonia.  Clin Pulm Med. 1999;  6 1-8
    Google Scholar
  • 11 Fahey T, Stocks N, Thomas T. Quantitative systematic review of randomized controlled trials comparing antibiotic with placebo for acute cough in adults.  BMJ. 1998;  316 906-910
    Google Scholar
  • 12 Farr B M, Kaiser D L, Harrison B DW, Connolly C K. Prediction of microbial etiology at admission to hospital for pneumonia from the presenting clinical features.  Thorax. 1984;  44 1031-1035
    Google Scholar
  • 13 Gennis P, Gallagher J, Falvo C, Baker S, Than W. Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgenograms in the emergency department.  J Emerg Med. 1989;  7 263-268
    Google Scholar
  • 14 Gonzales R, Steiner J F, Sande M A. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.  JAMA. 1997;  278 901-904
    Google Scholar
  • 15 Guidelines from the Infectious Diseases Society of America . Community-acquired pneumonia in adults: guidelines for management.  Clin Infect Dis. 2000;  26 811-838
    Google Scholar
  • 16 Heckerling P S. The need for chest roentgenogramms in adults with acute respiratory illness: clinical predictors.  Arch Intern Med. 1986;  146 1321-1324
    Google Scholar
  • 17 Heckerling P S, Tape T G, Wigton R S. et al . Clinical prediction rule for pulmonary infiltrates.  Ann Intern Med. 1990;  113 664-670
    Google Scholar
  • 18 Heckerling P S, Tape T G, Wigton R S. Relation of physicians’ predicted probabilities of pneumonia to their utilities for ordering chest x-rays to detect pneumonia.  Med Decis Making. 1992;  12 32-38
    Google Scholar
  • 19 Huchon G, Woodhead M. Management of adult community-acquired lower respiratory tract infections.  Eur Respir Rev. 1998;  8 391-426
    Google Scholar
  • 20 Lode H, Schaberg T. Pneumonie. Weißbuch Lunge.  Pneumologie. 1996;  50 592-594
    Google Scholar
  • 21 Macfarlane J T, Colville A, Guion A, Macfarlane R M, Rose D H. Prospective study of aetiology of adult lower-respiratory-tract infections in the community.  Lancet. 1993;  341 511-514
    Google Scholar
  • 22 Macfarlane J, Holmes W, Macfarlane R. et al . Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community.  Thorax. 2001;  56 109-114
    Google Scholar
  • 23 Meehan T P, Fine M J, Krmholz H M. et al . Quality of care, process, and outcomes in elderly patients with pneumonia.  JAMA. 1997;  278 2080-2084
    Google Scholar
  • 24 Melbye H, Straume B, Aasebo U, Dale K. Diagnosis of pneumonia in adults in general practice: relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard.  Scand J Prim Health Care. 1992;  10 226-233
    Google Scholar
  • 25 Melbye H, Dale K. Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia.  Acta Radiol. 1992;  33 79-81
    Google Scholar
  • 26 Metlay J P, Kapoor W N, Fine M J. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination.  JAMA. 1997;  278 1440-1445
    Google Scholar
  • 27 Metlay J P, Schulz R, Li Y H. et al . Influence of age on symptoms at presentation in patients with community-acquired pneumonia.  Arch Intern Med. 1997;  157 1453-1459
    Google Scholar
  • 28 Owen N. Clinical prediction of pneumonia (letter).  Ann Intern Med. 1991;  114 428-429
    Google Scholar
  • 29 Ruiz M, Ewig S, Marcos M A. et al . Etiology of community-acquired pneumonia - impact of age, comorbidity, and severity.  Am J Respir Crit Care Med. 1999;  160 397-405
    Google Scholar
  • 30 Ruiz M, Ewig S, Torres A. et al . Severe community-acquired pneumonia: risk factors and follow-up epidemiology.  Am J Respir Crit Care Med. 1999;  160 923-929
    Google Scholar
  • 31 Schilling R SF, Hughes J PW, Dingwall-Fordyce I. Disagreement between observers in an epidemiological study of respiratory disease.  BMJ. 1955;  1 65-68
    Google Scholar
  • 32 Simpson J CG, Hulse P, Taylor P M, Woodhead M. Do radiographic features of acute infection influence management of lower respiratory tract infections in the community?.  Eur Respir J. 1998;  12 1384-1387
    Google Scholar
  • 33 Singal B M, Hedges J R, Radack K L. Decision rules and clinical prediction of pneumonia: evaluation of low-yield criteria.  Ann Emerg Med. 1989;  18 13-20
    Google Scholar
  • 34 Spiteri M A, Cook D G, Clarke S W. Reliability of eliciting physical signs in examination of the chest.  Lancet. 1988;  1 873-875
    Google Scholar
  • 35 Wipf J E, Lipsky B A, Hirschmann J V. et al . Diagnosing pneumonia by physical examination: relevant or relic?.  Arch Intern Med. 1999;  159 1082-1087
    Google Scholar
  • 36 Woodhead M A, Gialdroni-Grassi G, Huchon G, Leophonte P, Manresa F, Schaberg T. Use of investigations of lower respiratory tract infection in the community: a European survey.  Eur Respir J. 1996;  9 1596-1600
    Google Scholar
  • 37 Young M, Marrie T J. Interobserver variability in the interpretation of chest roentgenogramms of patients with positive pneumonia.  Arch Intern Med. 1994;  154 2729-2732
    Google Scholar

Korrespondenz

Priv.-Doz. Dr.med. Santiago Ewig

Medizinische Poliklinik der Universität Bonn

Wilhelmstraße 35

53111 Bonn

Phone: 0228/287-2225

Fax: 0228/287-2112

Email: santiago.ewig@ukb.uni-bonn.de