Method of Heckerling et al for Prediction of Pneumonia in Adults with Acute Respiratory Illness

Description

The method of Heckerling et al can be used to predict pneumonic infiltrates in adults presenting with acute respiratory illness. This can help guide physicians in the ordering of diagnostic tests such as chest radiographs.

Patient population: adults with acute respiratory illness

Predictors:

(1) temperature > 37.8°C

(2) pulse rate > 100 beats per minute

(3) presence of rales on chest auscultation

(4) decreased breath sounds

(5) absence of asthma

Predictor	logistic coefficient	odds ratio	95% confidence interval
temperature > 37.8°C	0.494	2.69	1.73-4.17
pulse > 100 beats/min	0.428	2.35	1.52-3.65
rales present	0.658	3.73	2.43-5.72
decreased breath sounds	0.638	3.58	2.33-5.50
absence of asthma	0.691	3.98	1.89-8.42
intercept	-1.705	0.18	0.12-0.26

number of predictors present =

= (1 if temperature > 37.8°C, else 0) + (1 if pulse > 100 beats/min, else 0) + (1 if rales present, else 0) + (1 if breath sounds decreased, else 0) + (1 if asthma absent, else 0)

From the number of predictors present and the prevalence of pneumonia in the patient population, the probability of pneumonia can be predicted.

pneumonia	probability of pneumonia (in percent)
prevalence (%)	5 factors present	4 factors present	3 factors present	2 factors present	1 factor present	0 factors present
5	53	26	9	3	1	0.1
10	70	40	17	6	2	0.5
15	79	53	25	10	3	1
20	83	60	34	13	5	2
25	87	67	40	17	6	2.5
30	90	74	45	21	8	2.8
35	91	76	51	25	10	3
40	92	80	56	29	11	4
45	94	83	62	33	13	5
50	95	86	67	39	16	6
55	96	88	70	43	19	7
60	97	90	75	49	22	8
65	97.25	92	77	52	27	10
70	97.5	94	82	60	30	12
75	98	95	85	63	35	15
80	98.5	96	88	70	43	18
85	99	97.5	92	78	50	25
90	99.5	98	94	83	62	35
95	99.9	99	97.5	92	77	50

(extracted from nomogram in Figure 2, page 668)

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Description

Specialty

ICD-10