Analysis of predictive factors for pneumonia in febrile patients with nondiagnostic chest radiography
- Author:
Myungho JEONG
1
;
Bora CHAE
;
Yoon-Seon LEE
Author Information
1. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Journal of the Korean Society of Emergency Medicine
2026;37(2):67-74
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Objective:Pneumonia can be life-threatening, but it is challenging to diagnose because of the low accuracy of chest Xray (CXR), the diagnostic standard. This study examined predictors of pneumonia on computed tomography (CT) in febrile patients with nondiagnostic CXR.
Methods:This was a retrospective case-control study conducted in the emergency department (ED) of a tertiary referral center between November 2019 and October 2020. Among adult febrile patients who underwent CXR and a CT scan, 105 cases with pneumonia on CT and 105 controls without pneumonia on CT were consecutively included. None of the patients had a fever focus or a nondiagnostic CXR at the initial work-up.
Results:Multivariate regression analysis revealed the following to be significantly associated with pneumonia on CT: male (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.04-4.07), lower respiratory symptoms (OR, 4.33; 95% CI, 1.93-9.72 for one symptom; OR, 7.64; 95% CI, 3.19-18.31 for two or more symptoms), peripheral oxygen saturation (SpO2) <95% (OR, 2.94; 95% CI, 1.03-8.42), body temperature ≥40.0°C (OR, 5.18; 95% CI, 1.14-23.63), and leukocytosis (OR, 2.26; 95% CI, 1.12-4.55). Blood urea nitrogen (BUN)/creatinine (Cr) ≥20 (OR, 2.14; 95% CI, 1.00-4.57) and absolute neutrophil count <500/mm3 (OR, 8.41; 95% CI, 0.81-87.57) tended to have an association with pneumonia on CT.
Conclusion:Males, lower respiratory tract symptoms, lower SpO2, higher body temperature, and leukocytosis were independent predictors of a diagnosis of pneumonia on CT with nondiagnostic CXR in febrile patients at the ED. In addition, neutropenia and an increased BUN-to-Cr ratio were important predictors of pneumonia.
