Clinical factors, C-reactive protein point of care test and chest X-ray in patients with pneumonia: A survey in primary care

Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging

When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18-79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007-2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs.

Correlation between serum levels of C-reactive protein and neonatal pneumonia: A protocol for systematic review and meta-analysis

BACKGROUND

Few studies have reported the correlation between serum levels of C-reactive protein (CRP) and neonatal pneumonia. The purpose of the present meta-analysis was to clarify whether an increased serum level of CRP accelerates the development of neonatal pneumonia.

METHODS

This protocol is conducted according to the preferred reporting items for systematic reviews and meta-analysis protocol (PRISMA-P) statement guidelines. Related articles were identified by searching PubMed, Embase, Cochrane Library, Web of Science, Science Direct, and CNKI databases. Two investigators extracted information according to the selection criteria and used a set of predefined criteria based on the Newcastle-Ottawa Scale (NOS) criteria to assess the studies. All calculations were carried out with Stata 12.0 (Stata Corp, College Station, TX).

RESULTS

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

CONCLUSION

We hypothesized that a higher serum CRP level is closely correlated with the progression of neonatal pneumonia. CRP as a general systemic inflammation biomarker may help clinicians to make difficult therapeutic decisions for neonatal pneumonia.

OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER

10.17605/OSF.IO/RGBMX.

Advanced Meta-Heuristics, Convolutional Neural Networks, and Feature Selectors for Efficient COVID-19 X-Ray Chest Image Classification

The chest X-ray is considered a significant clinical utility for basic examination and diagnosis. The human lung area can be affected by various infections, such as bacteria and viruses, leading to pneumonia. Efficient and reliable classification method facilities the diagnosis of such infections. Deep transfer learning has been introduced for pneumonia detection from chest X-rays in different models. However, there is still a need for further improvements in the feature extraction and advanced classification stages. This paper proposes a classification method with two stages to classify different cases from the chest X-ray images based on a proposed Advanced Squirrel Search Optimization Algorithm (ASSOA). The first stage is the feature learning and extraction processes based on a Convolutional Neural Network (CNN) model named ResNet-50 with image augmentation and dropout processes. The ASSOA algorithm is then applied to the extracted features for the feature selection process. Finally, the Multi-layer Perceptron (MLP) Neural Network's connection weights are optimized by the proposed ASSOA algorithm (using the selected features) to classify input cases. A Kaggle chest X-ray images (Pneumonia) dataset consists of 5,863 X-rays is employed in the experiments. The proposed ASSOA algorithm is compared with the basic Squirrel Search (SS) optimization algorithm, Grey Wolf Optimizer (GWO), and Genetic Algorithm (GA) for feature selection to validate its efficiency. The proposed (ASSOA + MLP) is also compared with other classifiers, based on (SS + MLP), (GWO + MLP), and (GA + MLP), in performance metrics. The proposed (ASSOA + MLP) algorithm achieved a classification mean accuracy of (99.26%). The ASSOA + MLP algorithm also achieved a classification mean accuracy of (99.7%) for a chest X-ray COVID-19 dataset tested from GitHub. The results and statistical tests demonstrate the high effectiveness of the proposed method in determining the infected cases.

C-reactive protein influences the doctor's degree of suspicion of pneumonia in primary care: a prospective observational study

BACKGROUND

In primary care, the diagnosis of pneumonia is often based on history and clinical examination alone. However, a previous study showed that the general practitioner's degree of suspicion correlates well with findings on chest X-ray, when the C-reactive protein (CRP) value is known.

OBJECTIVES

The present study aimed to investigate to what extent the physician's degree of suspicion is affected by the CRP level when community-acquired pneumonia is suspected in primary care.

METHODS

A prospective observational study was conducted at five primary health care centres in Sweden between October 2015 and December 2017. Adult patients (n = 266) consulting their health care centre with symptoms of lower respiratory tract infection, where the physician suspected pneumonia, were included consecutively. Anamnestic information and findings from clinical examination were documented in a case report form. All patients were tested for CRP. The physicians rated their degree of suspicion as 'unsure,' 'quite sure,' and 'sure' before and after the CRP result.

RESULTS

The degree of suspicion of pneumonia changed in 69% of the cases; most often to a lower degree (40%). In 28% of the cases, there was no longer any suspicion of pneumonia after CRP.

CONCLUSION

Our results indicate that CRP testing highly influences the physician's degree of suspicion of pneumonia in primary care and that it seems to be of most value when not sure of the diagnosis.

Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study

OBJECTIVES

The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics.

DESIGN

This was an intervention study conducted between September 2015 and December 2017.

SETTING

Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden.

INTERVENTION

All patients were referred for CXR when the physician´s suspicion of pneumonia was 'unsure', or 'quite sure' after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing.

SUBJECTS

A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients ≥18 years, with respiratory symptoms for more than 24 h. Main outcome measure: Antibiotic prescribing rate.

RESULTS

In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics.

CONCLUSION

This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing. Key Points Routine use of chest X-ray when the clinical diagnosis of pneumonia is uncertain has not been proven to result in lowered antibiotic prescribing rate. Physicians do not fully rely on chest X-ray outcome and to some extent prescribe antibiotics even if negative, when community-acquired pneumonia is suspected. Chest X-ray is already used in one out of four cases in routine primary care of pneumonia patients in Sweden.

Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers

BACKGROUND

Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care.

METHODS

From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model.

RESULTS

Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics.

CONCLUSIONS

Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.