Clinical Findings Versus X-Ray Findings In Patients Hospitalized For Influenza In H1n1 V Pandemic In Belgrade, Serbia

Background: During the pandemic influenza H1N1 v in 2009 in Belgrade, patients were hospitalized according to the clinical findings. Pre-set criteria were respected (temperature over 38C, difficulties in breathing, satO2 less than 95%, measured by pulse oxymetar), generally in the measure of experience of clinician at the admitting point, knowing that general condition can deteriorate quickly. At that moment oseltamivir was kept only for hospitalized patients. If possible x-rays of lungs were done immediately, more often the next morning. The aim of the study is to analyse how much clinical lungs-findings can predict influenza pneumonia. Methods: We compared clinical to rendgenological findings in 377 patients hospitalized during pandemic influenza, with suspicion of influenza pneumonia. Results: Patients's age ranged from 15 to 82 years. Male-female ratio was 1:0,84, mean age was 41,86 years; 189 (50,13%) patients were complaining of hard breathing; 82 (21,75%) had normal lungs findings, 91 (24,14%) had crackles (consistent with bronchitis), 14 (3,71%) had wheezing. On x-rays 292 (77,46%) had pneumonia, among them 82 (21,75%) bilateral, others unilateral, i.e. 85(22,54%) had no infiltrations. Our 46 (12,2%) patients had normal clinical findings and had no infiltrates on x-rays, but their general condition demanded hospitalization. Conclusion: It is well known that any kind of crackles means bronchitis, and that interstitial pneumonia is rendgenological diagnosis, but in pandemic situation our doctors tried to hospitalise only ones who had more pronounced signs of the disease and suspected pneumonia. They succeeded in making clinical diagnosis of interstitial pneumonia in 3,4:1, meaning that even in influenza, when interstitial pneumonia is suspected, clinical signs are of small value.