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Clinical predictors of pneumonia among children with wheezing

Bonnie Mathews1, Sonal Shah, Robert H Cleveland

  • 1Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.

Pediatrics
|July 1, 2009
PubMed

Insights

Pneumonia is uncommon in children with wheezing. Fever, abdominal pain, and low oxygen saturation may indicate pneumonia, but routine chest X-rays for afebrile wheezing children are not recommended.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Illness
  • Diagnostic Imaging

Background:

  • Wheezing is a common symptom in children presenting to the emergency department.
  • Distinguishing pneumonia from other causes of wheezing can be challenging.
  • Accurate diagnosis is crucial for appropriate management and resource allocation.

Purpose of the Study:

  • To identify factors associated with radiographically confirmed pneumonia in children with wheezing.
  • To inform clinical decision-making regarding the necessity of chest radiography in this population.

Main Methods:

  • Prospective cohort study of children aged 21 years or younger with wheezing in the ED.
  • Collection of historical and examination findings prior to radiography results.
  • Independent, blinded radiologist interpretation of chest radiographs.

Main Results:

  • Radiographic pneumonia was confirmed in 4.9% of 526 wheezing children.
  • Factors increasing pneumonia risk included home fever, abdominal pain, triage temperature ≥38°C, maximal ED temperature ≥38°C, and triage oxygen saturation <92%.
  • Afebrile children with wheezing had a low pneumonia rate (2.2%).

Conclusions:

  • Radiographic pneumonia is infrequent in children presenting with wheezing.
  • Clinical and historical factors can help guide the decision for chest X-rays.
  • Routine chest radiography should be avoided in wheezing children without fever.
Abstract

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