Abstract

A PROSPECTIVE STUDY ON CLINICAL AND RADIOLOGICAL RESOLUTION OF COMMUNITY-ACQUIRED PNEUMONIA

Author(s): A. Mohamed Musthafa1, P. T. James2, C. Ravindran3

BACKGROUND
Despite exhaustive literature on community-acquired pneumonia (CAP), studies assessing the rates of clinical and radiographic resolution among these patients are limited.
AIM
To study the duration for clinical and radiological resolution of community-acquired pneumonia and the factors leading on to delay in resolution.
METHODS
A prospective observational clinical study conducted in the Department of Pulmonary Medicine during the period of one year from August 2009. The severity of symptoms in patients with CAP were recorded through structured questionnaires at 0, 3, 7, and 14 days of treatment and the scores tabulated. Serial chest radiographs were taken at baseline and on days 7, 14, and 28. Radiographs were reviewed in sequence and the pattern and extent of opacities evaluated. Extent of opacity in the followup x-rays were compared with the baseline film. Kappa statistics used to measure interobserver agreement on radiological clearance. Chi square test was used to analyse qualitative variables. Quantitative variables between groups were compared using ANOVA and t test.
RESULTS
Of the total 51 patients, 46 (90%) were males. Clinical resolution occurred in 75% of patients at two weeks. Radiological resolution occurred in 43% by the end of 4 weeks and 78% at the end of 8 weeks. Females and those aged more than 60 years showed delay in resolution. Longer duration of symptoms prior to diagnosis and those with multilobar involvement showed delay in resolution.
CONCLUSION
Majority (75%) showed clinical resolution within a period of two weeks. Radiological resolution occurred in 43% at four weeks and in 78% at 8 weeks. Female sex, advanced age, longer duration of symptoms prior to diagnosis and multilobar involvement were associated with delay in resolution. Once clinical resolution has occurred, radiological resolution will eventually follow and a delay beyond 4 weeks doesn’t require concern especially in resource limited settings.