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Clinical history can provide clues for severe pneumonia
Neuman MI. Pediatrics. 2011; doi:10.1542/peds.2010-3367.
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A good clinical history may help decipher those children who are at risk for radiographic pneumonia, according to data published online this week.
Mark I. Neuman, MD, MPH, and colleagues from the division of emergency medicine and clinical research program at Children's Hospital Boston looked at 2,574 pediatric patients in their hospital. The researchers used pneumonia status as the dependent variable and historical and physical examination data as the independent variables. The researchers noted that hypoxia (defined as oxygen saturation ≥92%) was the strongest predictor of pneumonia (OR=3.6; 95% CI, 2.0–6.8), followed by extended fever, chest pain, focal rales, and poor oximetry levels at triage, as being the most common predictors of pneumonia in the 16% of patients who developed radiographic pneumonia. In addition, recursive partitioning analysis revealed that the rate of radiographic pneumonia was 7.6% among subjects with hypoxia, no history of fever, no focal decreased breath sounds and no focal rales.
“Historical and physical examination findings can be used to risk stratify children for risk of radiographic pneumonia,” the researchers concluded.
Investigators conducted the prospective cohort study in an urban pediatric ED and included patients aged younger than 21 years who had a chest radiograph performed for suspicion of pneumonia. Most of the patients (n=1,901) were aged younger than 5 years and were slightly more likely to be male (54%).
Patients diagnosed with pneumonia were split into two groups on the basis of an attending radiologist’s interpretation of the chest radiograph: (1) radiographic pneumonia (which included definite and equivocal cases of pneumonia) and (2) definite pneumonia. The researchers estimated a multivariate logistic regression model with pneumonia status as the dependent variable and the historical and physical examination findings as the independent variables.
The researchers noted some study limitations, specifically, their inability to evaluate the reliability of specific physical examination findings, and their inability to evaluate children in whom there was suspicion of pneumonia but a radiograph was not obtained.
The investigators urged continued research into the data at multiple facilities.
Disclosures: The study authors reported no relevant conflicts of interest.
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