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Identifying children with pneumonia in the emergency department
E Melinda Mahabee-Gittens1, Jacqueline Grupp-Phelan, Alan S Brody
1Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
Insights
Emergency physicians can identify pediatric pneumonia using clinical signs. Key indicators include age over 12 months, increased respiratory rate, low oxygen saturation, and nasal flaring in younger children.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Radiology
Background:
- Differentiating pediatric pneumonia clinically is crucial for emergency physicians.
- Accurate diagnosis impacts treatment and patient outcomes.
Purpose of the Study:
- To identify clinical predictors of radiographic pneumonia in young children.
- To aid emergency physicians in diagnosing pneumonia without immediate radiography.
Main Methods:
- Prospective cohort study of 510 children (2-59 months) with lower respiratory tract infection symptoms.
- All patients underwent chest radiography.
- Multivariate analysis used to determine significant clinical findings associated with pneumonia.
Main Results:
- Pneumonia was confirmed radiographically in 8.6% of patients.
- Clinical predictors included age >12 months (AOR 1.4), RR ≥50 (AOR 3.5), oxygen saturation ≤96% (AOR 4.6).
- Nasal flaring was significant in children ≤12 months (AOR 2.2).
Conclusions:
- A combination of clinical factors can help identify children with radiographic pneumonia.
- Age, respiratory rate, oxygen saturation, and nasal flaring are key indicators.
- These findings can guide clinical decision-making in pediatric lower respiratory tract infections.
Abstract:
Emergency physicians need to clinically differentiate children with and without radiographic evidence of pneumonia. In this prospective cohort study of 510 patients 2 to 59 months of age presenting with symptoms of lower respiratory tract infection, 100% were evaluated with chest radiography and 44 (8.6%) had pneumonia on chest radiography. With use of multivariate analysis, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) of the clinical findings significantly associated with focal infiltrates were age older than 12 months (AOR 1.4, CI 1.1-1.9), RR 50 or greater (AOR 3.5, CI 1.6-7.5), oxygen saturation 96% or less (AOR 4.6, CI 2.3-9.2), and nasal flaring (AOR 2.2 CI 1.2-4.0) in patients 12 months of age or younger. The combination of age older than 12 months, RR 50 or greater, oxygen saturation 96% or less, and in children under age 12 months, nasal flaring, can be used in determining which young children with lower respiratory tract infection symptoms have radiographic pneumonia.
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