Definitions

Hospital diagnosis is based on new radiographic changes on a chest radiograph in addition to symptoms and signs suggestive of pneumonia.

Recognised features of pneumonia include fever, dyspnoea, pleuritic chest pain, productive cough, tachypnoea and focal crepitations or bronchial breathing on chest auscultation. However, no prediction rules have shown reliable accuracy for diagnosing pneumonia in the absence of a chest radiograph.

The 2009 BTS guidelines propose the following definitions for CAP:

Patients managed in the community (without a chest radiograph)
  • Symptoms of an acute lower respiratory tract illness (cough and at least one other lower respiratory tract symptom eg breathlessness, pleuritic chest pain)

and

  • New focal chest signs on examination

and

  • At least one systemic feature (either a symptom complex of sweating, fevers, shivers, aches and pains and/or temperature of 38°C or more)

and

  • No other explanation for the illness, which is treated as CAP with antibiotics
(b) Patients admitted to hospital (with a chest radiograph)
  • Symptoms and signs consistent with an acute lower respiratory tract infection associated with new radiographic shadowing for which there is no other explanation (e.g. not pulmonary oedema or infarction)

and

  • The illness is the primary reason for hospital admission and is managed as pneumonia.

 

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