Acute lower respiratory tract infections: Symptoms, findings and management in Danish general practice

Background Acute lower respiratory tract infections (LRTIs) are among the most common infections managed in general practice. Objectives To describe differences in reported symptoms, findings and management of patients diagnosed with acute LRTIs, and to explore possible associations between these findings and being diagnosed with pneumonia. Methods During one winter season (2017 or 2018), a prospective registration of patients diagnosed with either acute bronchitis (ICPC-2: R78) or pneumonia (ICPC-2: R81) was conducted in Danish general practice for 20 days. A 42 item registration chart was filled in for each patient. Descriptive statistics, Pearson's chi-square test and multiple logistic regressions were used for data analysis. Results In total, 70 general practices participated with 1384 patients registered. Patients diagnosed with pneumonia were more often reported as having a fever, dyspnoea, increased purulent sputum, abnormal pulmonary auscultation/chest retractions, and were more often assessed as unwell by the healthcare professional, than those diagnosed with acute bronchitis. Very few patients had a chest X-ray. Contrary, most patients had a C-reactive protein (CRP) test performed (pneumonia: 83%; acute bronchitis: 71%). Respectively, 93% and 20% of patients were treated with antibiotics. Having a fever, an abnormal pulmonary auscultation/chest retractions or being assessed as unwell increased the likelihood of the diagnosis pneumonia at least fivefold. Even a slightly elevated CRP (≥11 mg/L) was positively associated with being diagnosed with pneumonia. Conclusion Danish healthcare professionals are highly influenced by symptoms, signs and CRP tests when diagnosing patients with acute LRTIs in general practice.