This was a study involving the emergency department and outpatient clinics of the David Grant United States Air Force (USAF) Medical Center, a tertiary care facility. Patients 18 years of age or older with acute respiratory tract symptoms and positive chest radiographs from October 1, 2004 through May 31, 2005 were included as positive cases. Controls were randomly selected from a review of negative chest radiograph reports with a clinical history of an acute respiratory illness over the same time period. Equivocal radiographs were treated as positive cases. Patients were excluded if they were under the age of 18 or in suspected cases of hospital-acquired or aspiration pneumonia.

The six clinical indicators included cough, sputum production, temperature, heart rate, respiratory rate, and findings on physical examination. Abnormal vital signs were defined as temperature of 100.5 degrees Fahrenheit (38 degrees Celsius) or greater, heart rate greater than or equal to 100 beats per minute, and respiratory rate greater than 20 breaths per minute. Positive physical examination findings consisted of the presence of crackles, decreased breath sounds, dullness to percussion, egophony, or rhonchi.

Inclusion Criteria:

• 18 years of age or older
• acute respiratory tract infection
• patients from outpatient clinics and the emergency department

Exclusion Criteria:

• under the age of 18
• suspected hospital-acquired pneumonia
• suspected aspiration pneumonia
• inpatients