Decision rule to predict pneumonia in children presented with acute febrile respiratory illness
Fiona Y Y Chan1, C T Lui1, C F Tse2
1Accident & Emergency Department, Tuen Mun Hospital, Hong Kong.
Insights
Physicians can use the Pediatric Acute Febrile Respiratory Illness (PAFRI) rule to help decide if a chest X-ray is needed for children with fever and respiratory symptoms. This rule shows high accuracy in identifying pneumonia, aiding clinical decisions.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support
- Respiratory Illness Diagnosis
Background:
- Diagnosing pneumonia in children with acute febrile respiratory symptoms, especially stable ones without distress, is challenging for physicians.
- Current diagnostic decisions for chest radiography rely on varied clinical assessments.
- A validated clinical prediction rule is needed to guide radiography decisions in this patient group.
Purpose of the Study:
- To derive and validate the Pediatric Acute Febrile Respiratory Illness (PAFRI) rule.
- To provide a decision-making tool for ordering chest radiographs in pediatric patients with acute febrile respiratory symptoms.
Main Methods:
- A multicenter prospective study involving 3 emergency departments.
- Recruitment of children under 6 years with acute onset fever and respiratory symptoms.
- Logistic regression and a split-sample method for rule derivation and validation.
Main Results:
- The PAFRI rule, derived from 5 weighted predictors, demonstrated a superior Area Under the ROC curve (0.733) compared to other rules.
- A PAFRI score of ≥0 achieved 91.7% sensitivity and 97.7% negative predictive value.
- Predictors included fever duration, chills, nasal symptoms, abnormal chest examination, and SpO2/tachypnea.
Conclusions:
- The PAFRI rule serves as a valuable reference tool for guiding chest radiography decisions in pediatric patients.
- The rule can assist in patient triage and prioritizing clinical care.
- Further validation of the PAFRI rule is recommended.
Background:
It is a frequent challenge for physicians to identify pneumonia in patients with acute febrile respiratory symptoms, particularly in stable pediatric patients without respiratory distress. A decision rule is required to assist judgement on the need of ordering a chest radiograph.
Method:
This was a multicenter prospective study in 3 emergency departments. Children younger than 6 years old with an acute onset of fever and respiratory symptoms were recruited. Split sample method was adopted for derivation and validation of the Pediatric Acute Febrile Respiratory Illness rule (PAFRI Rule). PAFRI was derived from logistic regression with weighting based on adjusted odds ratios.
Results:
Out of 967 children evaluated, 530 had taken chest radiograph examination, with 91 demonstrated evidence of pneumonia on radiograph. PAFRI Rule was derived from logistic regression with 5 weighed predictors: duration of fever <3 days (0 points), 3-4 days (2 points), 5-6 days (4 points), ≥7 days (5 points), chills (2 points), nasal symptoms (-2 points), abnormal chest examination (3 points), SpO2 ≤96% or tachypnea (3 points). The Area under ROC curve of the PAFRI Rule, the Bilkis Decision Rule and Bilkis Simpler Rule were 0.733, 0.600 and 0.579 respectively. A PAFRI score of ≥0 gives a sensitivity of 91.7% and negative predictive value of 97.7%.
Conclusion:
PAFRI rule can be used as a reference tool for guiding the need for taking Chest radiograph examination for pediatric patients. While promising, the PAFRI rule requires further validation.
What'S Known On This Subject:
It is often a challenge for physicians to identify pneumonia in children acutely febrile with respiratory symptoms, particularly in those who are stable without respiratory distress. The decision to order chest radiograph was based on clinical assessment with heterogenous practice. A valid and verified clinical prediction rule for ordering chest radiograph examination for stable febrile children without signs of respiratory distress would therefore assist in management of this group of patients.
What This Study Adds:
The PAFRI rule, based on parameters from clinical bedside assessment, can be used as a reference tool for guiding the need for referral to emergency department or taking use of chest radiograph for pediatric patients, and triaging for higher priority of clinical care.
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