Do published guidelines predict pneumonia in children presenting to an urban ED?
OBJECTIVE
In 1997, a Canadian task force published evidence-based guidelines for diagnosing pediatric pneumonia, concluding that the absence of each of four signs (ie, respiratory distress, tachypnea, crackles, and decreased breath sounds) accurately excludes pneumonia. The study was performed to evaluate the accuracy of these guidelines in predicting pneumonia in young children.


METHODS
This was an observational study conducted over a 4-month period at an urban emergency department with 80,000 annual visits, approximately 20% of which were children < or =5 years old. Consecutive children < or =5 years old who underwent chest radiography were enrolled. Prior to ordering radiographs, treating physicians were required to enter specific patient signs and symptoms into a computerized database. World Health Organization criteria were used to define tachypnea. Sensitivity, specificity, and predictive values of the task force guidelines in predicting pneumonia were calculated.


RESULTS
Three hundred twenty-nine children, including 67 (20%) with pneumonia, were enrolled. Guidelines were 45% sensitive (95% confidence interval (CI) = 33-58) and 66% specific (95% CI = 60-72) for diagnosing pneumonia. Positive and negative predictive values were 25% (95% CI = 18-34) and 82% (95% CI = 77-87), respectively.


CONCLUSIONS
Previously published evidence-based guidelines for excluding pediatric pneumonia were found unreliable in this study.
Rothrock
S G
SG
Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida 32806, USA.
Green
S M
SM
Fanelli
J M
JM
Cruzen
E
E
Costanzo
K A
KA
Pagane
J
J
D002675:Child, Preschool; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D006786:Hospitals, Urban; D006801:Humans; D010372:Pediatrics / Q000592:standards*; D011014:Pneumonia / Q000175:diagnosis*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires