title: Children with fever and cough at emergency care: diagnostic accuracy of a clinical model to identify children at low risk of pneumonia.
abstract: OBJECTIVE
  To develop and validate a prediction model for the early identification of children with pneumonia in emergency care settings.
  
  
  METHODS
  This was a diagnostic study with derivation and validation of multivariate logistic regression models. This study was carried out on children aged 1 month-16 years presenting with fever and cough visiting the pediatric emergency department of the Erasmus MC-Sophia, Rotterdam, the Netherlands (derivation population, n=504); Pediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK (validation population 1, n=420); Accident & Emergency Department, Queen's Medical Centre, Nottingham, UK (validation population 2, n=366). The outcome pneumonia is defined by the presence of pulmonary consolidations on chest radiograph or follow-up.
  
  
  RESULTS
  In population 1, 78 (16%) children were diagnosed with pneumonia; in populations 2 and 3, this number was 58 (14%) and 27 (7%), respectively. A simple clinical decision rule on the basis of ill appearance, tachypnea, decreased oxygen saturation, and elevated serum C-reactive protein categorized children as being at a low (<5%) or a high (>16%) risk of pneumonia. The rule yielded a discriminative value of 0.79 (0.69-0.89) in the Rotterdam population and was validated well in the other two populations.
  
  
  CONCLUSIONS
  The risk of pneumonia can be assessed using three key clinical characteristics - overall assessment of the severity of illness, breathing rate, and oxygen saturation. Serum C-reactive protein contributes to the prediction of an intermediate risk of pneumonia in children. Children with a low risk of developing pneumonia with vital signs in the normal range can be discharged with effective safety netting, requiring neither antibiotics nor radiographs.
authors.affiliation: Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. r.oostenbrink@erasmusmc.nl
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
authors.forename: Monica
authors.initials: M
authors.lastname: Lakhanpaul
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Nigel
authors.initials: N
authors.lastname: Coad
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000175:diagnosis* / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008962:Models, Theoretical; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors