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ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients

Kirsch, Jacobo MD*; Ramirez, José MD*; Mohammed, Tan-Lucien H. MD; Amorosa, Judith K. MD; Brown, Kathleen MD§; Dyer, Debra Sue MD; Ginsburg, Mark E. MD¶,♯; Heitkamp, Darel E. MD**; Jeudy, Jean MD††; MacMahon, Heber MB, BCh‡‡; Ravenel, James G. MD§§; Saleh, Anthony G. MD∥∥,¶¶; Shah, Rakesh D. MD♯♯;

doi: 10.1097/RTI.0b013e31820ffe0f
Web Exclusive Content—Appropriateness Criteria Review

Acute respiratory illness is defined as one or more of the following: cough, sputum production, chest pain, or dyspnea (with or without fever). The workup of these patients depends on many factors, including clinical presentation and the suspected etiology. This study reviews the literature on the indications and usefulness of radiologic studies for the evaluation of acute respiratory illness in the immunocompetent patient. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology. Chest radiographs are usually appropriate in (1) patients with positive physical examination or risk factors for pneumonia, (2) for the assessment of complicated pneumonia, or (3) in cases of emerging infections and biological warfare agents such as severe acute respiratory syndrome, H1N1, and anthrax. Computed tomography, although having a more limited role, is usually appropriate (1) in the assessment of complicated pneumonia and (2) in patients with suspected severe acute respiratory syndrome, H1N1, or anthrax and a normal radiograph.

*Division of Radiology, Cleveland Clinic, Weston, FL

Imaging institute, Cleveland Clinic Foundation, Cleveland, OH

Department of Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ

§Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA

Department of Radiology, National Jewish Health, Denver, CO

Department of Surgery, Columbia University, New York

∥∥Institute of Asthma and Lung Disease, New York Methodist Hospital, Brooklyn

♯♯Department of Radiology, North Shore University Hospital, Manhasset, NY

Society of Thoracic Surgeons, Chicago, IL

‡‡Department of Radiology, University of Chicago Hospital, Chicago

¶¶American College of Chest Physicians, Northbrook, IL

**Department of Radiology, Indiana University, Indianapolis, IN

††Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD

§§Department of Radiology, Medical University of South Carolina, Charleston, SC

This article is a summary of the complete version of this topic, which is available on the ACR website at Practitioners are encouraged to refer to the complete version.

The American College of Radiology (ACR) seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria® through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.

Reprints: Department of Quality & Safety, American College of Radiology, 1891 Preston White Dr., Reston, VA 20191,

© 2011 Lippincott Williams & Wilkins, Inc.