Identifying children with pneumonia in the emergency department.
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.
Mahabee-Gittens
E Melinda
EM
Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
Grupp-Phelan
Jacqueline
J
Brody
Alan S
AS
Donnelly
Lane F
LF
Bracey
Sheryl E Allen
SE
Duma
Elena M
EM
Mallory
Mia L
ML
Slap
Gail B
GB
D017677:Age Distribution; D000553:Ambulatory Care / Q000379:methods*; D001774:Blood Chemical Analysis; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000175:diagnosis; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010101:Oxygen Consumption / Q000502:physiology; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014481:United States