title: The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study.
abstract: To develop a case definition for the Pneumonia Etiology Research for Child Health (PERCH) project, we sought a widely acceptable classification that was linked to existing pneumonia research and focused on very severe cases. We began with the World Health Organization's classification of severe/very severe pneumonia and refined it through literature reviews and a 2-stage process of expert consultation. PERCH will study hospitalized children, aged 1-59 months, with pneumonia who present with cough or difficulty breathing and have either severe pneumonia (lower chest wall indrawing) or very severe pneumonia (central cyanosis, difficulty breastfeeding/drinking, vomiting everything, convulsions, lethargy, unconsciousness, or head nodding). It will exclude patients with recent hospitalization and children with wheeze whose indrawing resolves after bronchodilator therapy. The PERCH investigators agreed upon standard interpretations of the symptoms and signs. These will be maintained by a clinical standardization monitor who conducts repeated instruction at each site and by recurrent local training and testing.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. ascott@ikilifi.org
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
authors.forename: Chizoba
authors.initials: C
authors.lastname: Wonodi
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Moïsi
authors.forename: Maria
authors.initials: M
authors.lastname: Deloria-Knoll
authors.forename: Andrea N
authors.initials: AN
authors.lastname: DeLuca
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Karron
authors.forename: Niranjan
authors.initials: N
authors.lastname: Bhat
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.forename: Jane
authors.initials: J
authors.lastname: Crawley
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
authors.forename: Katherine L
authors.initials: KL
authors.lastname: O'Brien
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000465:Algorithms; D002669:Child Welfare; D002673:Child, Hospitalized; D002675:Child, Preschool; D003371:Cough / Q000150:complications; D003906:Developing Countries; D004417:Dyspnea / Q000150:complications; D015340:Epidemiologic Research Design; D006801:Humans; D007223:Infant; D018579:Patient Selection; D011014:Pneumonia / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods / Q000592:standards*; D012720:Severity of Illness Index; D014944:World Health Organization