Diagnostic approach to acquired immunodeficient patients with pulmonary symptoms: A decision analytic strategy

PCP is a common cause of mortality in patients with AIDS. This study uses decision analysis to determine the optimal management of an AIDS patient who has respiratory symptoms suggestive of PCP. A decision tree is constructed with four initial branches corresponding to the available clinical options: (1) observation with neither a diagnostic procedure nor medical therapy; (2) empiric drug therapy for PCP; (3) diagnostic bronchoscopy with BAL to establish the diagnosis of PCP; (4) open lung biopsy to establish a specific diagnosis. The decision tree is used to ascertain the clinical strategy leading to the least likelihood of morbidity and mortality. This model suggests that optimal management of most patients is empiric drug therapy for PCP. This conclusion appears to be contrary to the way patients are managed by most clinicians.