title: The validity of clinical criteria in predicting pneumonia among children under five years of age.
abstract: BACKGROUND
  Pneumonia is a major cause of morbidity and mortality, especially among infant and young children. Early diagnosis and treatment is essential to reduce the risk. To achieve this, physicians require high quality diagnostic indicators. The aim of the present study is to assess the validity of clinical symptoms and signs in predicting pneumonia among children below the age of 5 years.
  
  
  METHODS
  This is a case series study for a sample of 103 children aged 4 days-59 months who were admitted to Al-Khanssa Teaching Hospital, Mosul, Iraq, suffering from respiratory symptoms and for whom a chest x-ray was requested. Sensitivity, specificity, predictive values and likelihood ratios were estimated for each clinical criterion.
  
  
  RESULTS
  Pneumonia was diagnosed on radiological bases in about 70% of the patients. All symptoms had high sensitivity with very low specificity. The best positive predictive values for symptoms were for fast and difficult breathing. However, the signs of Crackle, Tachypnoea, nasal flarring and chest indrawing yielded the best sensitivity estimates. Moreover, a body temperature of ≥38 °C was the best single predictor of pneumonia with a sensitivity of 67% and specificity of 75.8%. The absence of the 3 signs (nasal flaring, chest indrawing and crackles) ruled out pneumonia effectively. The sensitivity of this combination of signs was 98.6%. Detecting a body temperature ≥38 °C and grunting simultaneously was adequate to confirm the disease.
  
  
  CONCLUSIONS
  The study suggests that using clinical criteria in combination could improve physicians' prediction of pneumonia among children.
authors.affiliation: Mosul Medical College, Mosul, Iraq.
authors.forename: Samim A
authors.initials: SA
authors.lastname: Al-Dabbagh
authors.forename: Sinan N
authors.initials: SN
authors.lastname: Al-Zubaidi