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.


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.


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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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