Pneumonia recovery: discrepancies in perspectives of the radiologist, physician and patient

J Gen Intern Med. 2010 Mar;25(3):203-6. doi: 10.1007/s11606-009-1182-7. Epub 2009 Dec 5.


Background: Chest radiographs are often used to diagnose community-acquired pneumonia (CAP), to monitor response to treatment and to ensure complete resolution of pneumonia. However, radiological exams may not reflect the actual clinical condition of the patient.

Objective: To compare the radiographic resolution of mild to moderately severe CAP to resolution of clinical symptoms as assessed by the physician or rated by the patient.

Design: Prospective cohort study.

Participants: One hundred nineteen patients admitted because of mild to moderately severe CAP with new pulmonary opacities.

Main measures: Radiographic resolution and clinical cure of CAP were determined at day 10 and 28. Radiographic resolution was defined as the absence of infection-related abnormalities; clinical cure was rated by the physician and defined by improvement of signs and symptoms. In addition, the CAP score, a patient-based symptom score, was calculated.

Key results: Radiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3-16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure.

Conclusions: In mild to moderately severe CAP, resolution of radiographic abnormalities and resolution of symptoms scored by the patient lag behind clinical cure assessed by physicians. Monitoring a favorable disease process by routine follow-up chest radiographs seems to have no additional value above following a patient's clinical course.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Community-Acquired Infections / diagnostic imaging
  • Community-Acquired Infections / rehabilitation
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Patient Participation* / psychology
  • Physicians* / psychology
  • Pneumonia / diagnostic imaging*
  • Pneumonia / rehabilitation*
  • Prospective Studies
  • Radiography
  • Radiology*
  • Recovery of Function* / physiology