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.
Abbreviations: HCAP: Healthcare-associated Pneumonia

Respiratory Tract Infection Symptoms: ❑ Fever ❑ Cough with sputum ❑ Dyspnea ❑ Pleuritic chest pain

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

Order Labs: ❑ Complete blood count (CBC) ❑ Blood urea nitrogen (BUN) ❑ Sputum gram stain ❑ Sputum culture ❑ Blood culture if necessary ❑ If suspecting atypical pneumonia obtain: ❑ Urine legionella antigen ❑ Enyzme Immunoassay (EIA) ❑ Immunofluorescence ❑ Polymerase chain reaction (PCR) for atypical and viral including influenza

❑ 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

Does the patient meets any of the following criteria for HCAP? Hospitalized in an acute care hospital for 2 or more days within 90 days of the infection; Resided in a nursing home or long-term care facility; Received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; Attended a hospital or hemodialysis clinic

YES

NO

Does the infection occurred ≥48 hours after admission and it was not present at admission?

The patient has CAP Severity Criteria