Journal ArticleDOI
Prediction of Pneumonia in a Pediatric Emergency Department
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TLDR
Historical and physical examination findings can be used to risk stratify children for risk of radiographic pneumonia in children who present with suspicion for pneumonia in the emergency department.Abstract:
OBJECTIVE: To study the association between historical and physical examination findings and radiographic pneumonia in children who present with suspicion for pneumonia in the emergency department, and to develop a clinical decision rule for the use of chest radiography. METHODS: We conducted a prospective cohort study in an urban pediatric emergency department of patients younger than 21 who had a chest radiograph performed for suspicion of pneumonia (n = 2574). Pneumonia was categorized into 2 groups on the basis of an attending radiologist interpretation of the chest radiograph: radiographic pneumonia (includes definite and equivocal cases of pneumonia) and definite pneumonia. We estimated a multivariate logistic regression model with pneumonia status as the dependent variable and the historical and physical examination findings as the independent variables. We also performed a recursive partitioning analysis. RESULTS: Sixteen percent of patients had radiographic pneumonia. History of chest pain, focal rales, duration of fever, and oximetry levels at triage were significant predictors of pneumonia. The presence of tachypnea, retractions, and grunting were not associated with pneumonia. Hypoxia (oxygen saturation ≤92%) was the strongest predictor of pneumonia (odds ratio: 3.6 [95% confidence interval (CI): 2.0–6.8]). Recursive partitioning analysis revealed that among subjects with O2 saturation >92%, no history of fever, no focal decreased breath sounds, and no focal rales, the rate of radiographic pneumonia was 7.6% (95% CI: 5.3–10.0) and definite pneumonia was 2.9% (95% CI: 1.4–4.4). CONCLUSION: Historical and physical examination findings can be used to risk stratify children for risk of radiographic pneumonia.read more
Citations
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Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis
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References
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Journal ArticleDOI
Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination.
TL;DR: Some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary.
Journal Article
A practical guide for the diagnosis and treatment of pediatric pneumonia
TL;DR: These guidelines are the only guidelines to address antimicrobial treatment from an age-related, etiologic perspective and should reduce costs associated with unnecessary investigations and complications due to inappropriate treatment.
Journal ArticleDOI
Occult Pneumonias: Empiric Chest Radiographs in Febrile Children With Leukocytosis
TL;DR: Empiric chest radiographs in highly febrile children with leukocytosis and no findings of pneumonia frequently reveal occult pneumonias and should be considered a routine diagnostic test in children with a temperature of 39 degreesC or greater and WBC count of 20,000/mm3 or greater without an alternative major source of infection.
Journal ArticleDOI
Clinical Predictors of Pneumonia As a Guide to Ordering Chest Roentgenograms
TL;DR: To develop criteria for a more efficient approach to the ordering of chest roentgenograms, patients with fever or respiratory symptoms who were being evaluated with this diagnostic test were prospectively monitored.
Journal ArticleDOI
Can We Predict Which Children With Clinically Suspected Pneumonia Will Have the Presence of Focal Infiltrates on Chest Radiographs
TL;DR: A multivariate prediction rule shows promise for the accurate prediction of pneumonia in children, and patients with focal infiltrates were more likely in this study to have a history of fever, tachypnea, increased heart rate, retractions, grunting, crackles, or decreased breath sounds.
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