Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
ReplyCorrespondence

Response: Re: Signs and Symptoms That Rule Out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis

Christian S. Marchello and Mark H. Ebell
The Journal of the American Board of Family Medicine September 2019, 32 (5) 753-754; DOI: https://doi.org/10.3122/jabfm.2019.05.190231
Christian S. Marchello
Center for International Health, University of Otago, Dunedin, New Zealand
PhD, MT(ASCP)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: christian.marchello@otago.ac.nz
Mark H. Ebell
MD, MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor: We thank Dr. Kazal for the comment on our publication “Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.”1 Not only is lung ultrasonography a possible alternative to chest radiography (CXR) for the diagnosis of community-acquired pneumonia (CAP)2,3 but also they can be useful for the differential diagnosis of chest pain and dyspnea in the emergency department.4,5 We agree that point-of-care ultrasound (POCUS) should be explored in future studies on clinical decision rules for CAP, in addition to other point-of-care (POC) tests such as c-reactive protein.

However, POCUS is not yet ubiquitous nor has it replaced CXR as the current reference standard for diagnosing CAP. We express caution about the broad use of POCUS, as it suffers from subjective interpretation where interrater reliability varies6 and should be limited to clinicians with sufficient training and adequate patient volume.7 Most previous studies have been done in the emergency department or inpatient settings where there is a higher volume; whether primary care clinicians can duplicate that accuracy with lower volume requires further study. In addition, because pneumonia is relatively rare in primary care patients (about 3% to 4% of patients with lower respiratory tract symptoms), even a fairly accurate test can have a poor positive predictive value, leading to antibiotic overuse. We, therefore, advocate that future studies focus on the integration of simple heuristics, the overall clinical impression,8 validated clinical decision rules, and validated POC tests (eg, c-reactive protein)9 to identify patients at very low risk of CAP in the outpatient setting, as well as those who may benefit for further diagnostic testing, whether it be CXR or POCUS.

Notes

  • To see this article online, please go to: http://jabfm.org/content/32/5/000.full.

References

  1. 1.↵
    1. Marchello CS,
    2. Ebell MH,
    3. Dale AP,
    4. Harvill ET,
    5. Shen Y,
    6. Whalen CC
    . Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: a systematic review and meta-analysis. J Am Board Fam Med 2019;32:234–47.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Pereda MA,
    2. Chavez MA,
    3. Hooper-Miele CC,
    4. et al
    . Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 2015;135:714–22.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Chavez MA,
    2. Shams N,
    3. Ellington LE,
    4. et al
    . Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res 2014;15:50.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Buhumaid RE,
    2. St-Cyr Bourque J,
    3. Shokoohi H,
    4. Ma IWY,
    5. Longacre M,
    6. Liteplo AS
    . Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med 2019;37:298–303.
    OpenUrl
  5. 5.↵
    1. Zanobetti M,
    2. Scorpiniti M,
    3. Gigli C,
    4. et al
    . Point-of-care ultrasonography for evaluation of acute dyspnea in the ED. Chest 2017;151:1295–301.
    OpenUrl
  6. 6.↵
    1. Gravel CA,
    2. Monuteaux MC,
    3. Levy JA,
    4. Miller AF,
    5. Vieira RL,
    6. Bachur RG
    . Interrater reliability of pediatric point-of-care lung ultrasound findings. Am J Emerg Med. In press.
  7. 7.↵
    1. Ebell M
    . Point-of-care ultrasonography: an effective tool when used appropriately. Am Fam Physician 2019;99:143.
    OpenUrl
  8. 8.↵
    1. Dale AP,
    2. Marchello CS,
    3. Ebell MH
    . Clinical gestalt to diagnose pneumonia, sinusitis, and pharyngitis: a meta-analysis. Br J Gen Pract. In press.
  9. 9.↵
    1. van Vugt SF,
    2. Broekhuizen BD,
    3. Lammens C,
    4. et al
    . Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: diagnostic study. BMJ 2013;346:f2450.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 32 (5)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 5
September-October 2019
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Response: Re: Signs and Symptoms That Rule Out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
12 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Response: Re: Signs and Symptoms That Rule Out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis
Christian S. Marchello, Mark H. Ebell
The Journal of the American Board of Family Medicine Sep 2019, 32 (5) 753-754; DOI: 10.3122/jabfm.2019.05.190231

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Response: Re: Signs and Symptoms That Rule Out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis
Christian S. Marchello, Mark H. Ebell
The Journal of the American Board of Family Medicine Sep 2019, 32 (5) 753-754; DOI: 10.3122/jabfm.2019.05.190231
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Notes
    • References
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hepatitis C Treatment Knowledge, Attitudes, and Practices Among Primary Care Providers—Los Angeles County, 2023
  • Re: Factors Influencing Patient Confidence in Screening Mammography
  • Re: Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings
Show more Correspondence

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire