Letters to the Editor

Exclusion Criteria Important in Use of Clinical Decision Rules

Am Fam Physician. 2006 Sep 15;74(6):921.

to the editor: In the article, “Diagnosis and Treatment of Community-Acquired Pneumonia,”1 the discussion of outpatient versus inpatient treatment did not list the absolute contraindications to outpatient treatment. These contraindications include: hypoxemia (oxygen saturation less than 90 percent while patient is breathing room air), hemodynamic instability, active coexisting condition requiring hospitalization, and inability to tolerate oral medications.2 When applying a clinical decision rule to an individual patient, it is imperative to recognize exclusion criteria to avoid misapplication of the rule.

REFERENCES

1. Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73:442–50.

2. Halm EA, Teirstein AS. Clinical practice: management of community-acquired pneumonia. N Engl J Med. 2002;347:2039–45.

editor’s note: This letter was sent to the authors of “Diagnosis and Treatment of Community-Acquired Pneumonia,” who declined to reply.

 

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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