Pneumonia diagnostic algorithm

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

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Diagnostic Algorithm

Shown below is an algorithm for the diagnostic approach of pneumonia.

Most common symptoms: ❑ Fever ❑ Cough with sputum ❑ Dyspnea ❑ Pleuritic chest pain

Physical Examination: ❑ Fever and/or ❑ Tachypnea and/or ❑ Respiratory examination: ❑ Dull percussion on affected side ❑ Bronchial breath sounds ❑ Rales and/or ❑ Increased vocal fremitus ❑ Whispered pectoriloquy ❑ Pleural friction rub

Order Labs: ❑ Order complete blood count (CBC) ❑ Check Blood urea nitrogen (BUN) ❑ Perform sputum gram stain ❑ Sputum culture ❑ Blood culture ❑ If suspecting atypical pneumonia obtain: ❑ Urine legionella antigen ❑ Enyzme Immunoassay (EIA) ❑ Immunofluorescence ❑ Polymerase chain reaction (PCR) for atypical and viral including influenza ❑ Influenza testing during influenza season

❑ Order a chest X-ray if the patient presents with any of the following: Fever (>37.8° C / 100° F) Tachypnea (> 20 breaths/min) Tachycardia (> 100 bpm) Decreased breath sounds and crackles in the physical exam