Pneumonia Among Children Presenting to the Emergency Department With Chest Pain

Chest radiographs (CXRs) are often performed among children presenting to the emergency department (ED) with chest pain. Given the limited data on this practice, we sought to evaluate the risk of pneumonia among children presenting to an ED with chest pain and to further identify children at low risk of pneumonia.

We performed a secondary analysis of a prospective study enrolling children 5 to 18 years of age with chest pain who had a CXR performed for clinical suspicion of pneumonia. We compared the characteristics of children with and without pneumonia and used multivariable analyses to identify characteristics associated with radiographic pneumonia.

A total of 240 children with chest pain undergoing CXR for clinical suspicion of pneumonia were enrolled [median age 11.5 years (IQR: 7.6, 15.4)]. Radiographic pneumonia was observed in 46 children (19%). The odds of pneumonia were higher among children with fever (aOR: 3.5, 95% CI: 1.6, 7.8), tachypnea (aOR: 2.7, 95% CI: 1.2, 6.2), crackles (aOR: 2.3, 95% CI: 1.1, 5.0), and diminished breath sounds (aOR: 2.5, 95% CI: 1.2, 5.1) on auscultation. A total of 45 of 46 children with pneumonia had one or more of the following: fever, tachypnea, crackles, or decreased breath sounds on auscultation (sensitivity 97.8%, 95% CI: 88.5%, 99.9%).

Approximately 1 in 5 children presenting with chest pain and undergoing CXR had radiographic pneumonia. Pneumonia may be safely excluded among children with chest pain if there is no fever, tachypnea, crackles, or diminished breath sounds on examination.