Signs and Evidence

Making clinical sense of scientific data


Beware of the limitations of this tool

Pneumonia in adults

Calculated pretest probability: 1.5 %
Relevant inclusion criteria: All adults 



Clinical signs

5Dullness on percussion
7Decreased breath sounds on examination
8Heart rate > 100 BPM
9SpO2 < 95%

To further investigations

Sources used:

1.Moore M et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study. European Respiratory Journal 2017 50: 1700434
2.Holm A et al. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Br J Gen Pract. 2007 Jul 1; 57(540): 547–554
3.Heckerling PS et al. Clinical prediction rule for pulmonary infiltrates. Annals of Internal Medicine 1990 November 1, 113 (9): 664-70
4.Saldias PF et al. Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults. Rev Med Chil. 2007;135:143–150
5.Diehr P et al. Prediction of pneumonia in outpatients with acute cough–a statistical approach. J Chronic Dis. 1984;37:215–25
6.Melbye H et al. Diagnosis of pneumonia in adults in general practice. Relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference stan- dard. Scand J Prim Health Care. 1992;10:226–33
7.Kern DG et al. Auscultated forced expiratory time as a clinical and epidemiologic test of airway obstruction. Chest. 1991;100:636–9
8.Gennis P et al. Clinical criteria for the detection of pneumonia in adults: guidelines for ordering chest roentgen- ograms in the emergency department. J Emerg Med. 1989;7:263–8
9.Laursen CB et al. Diagnostic performance of chest X-ray for the diagnosis of community acquired pneumonia in acute admitted patients with respiratory symptoms. Scand J Trauma Resusc Emerg Med. 2013; 21(Suppl 2): A21
10.Ticinesi A et al. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Medicine: July 2016 - Volume 95 - Issue 27 - p e4153
11.Nazerian P et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med. 2015 May;33(5):620-5
12.Bourcier JE et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. American Journal of Emergency Medicine 32 (2014) 115–118
13.Xia Y et al. Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis. Journal Of Thoracic Disease, 8(10), 2822-2831
14.Le Bel J. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan. Crit Care. 2015; 19: 366
15.NICE clinical guideline: Pneumonia scope (September 2012)