title: Clinical features and inflammatory markers in pediatric pneumonia: a prospective study.
abstract: In this prospective, observational study on previously healthy children <18 years, we aimed to study the diagnostic ability of clinical features and inflammatory markers to (i) predict pathologic chest radiography in suspected pneumonia and (ii) differentiate etiology in radiological proven pneumonia. In 394 cases of suspected pneumonia, 265 (67%) had radiographs consistent with pneumonia; 34/265 had proof of bacterial etiology. Of the cases, 86.5% had received pneumococcal conjugate vaccine. In suspected pneumonia, positive chest radiography was significantly associated with increasing C-reactive protein (CRP) values, higher age, and SpO2≤92% in multivariate logistic regression, OR 1.06 (95% CI 1.03 to 1.09), OR 1.09 (95% CI 1.00 to1.18), and OR 2.71 (95% CI 1.42 to 5.18), respectively. In proven pneumonia, bacterial pneumonia was significantly differentiated from viral/atypical pneumonia by increasing CRP values and SpO2>92% in multivariate logistic regression, OR 1.09 (95% CI 1.05 to 1.14) and OR 0.23 (95% CI 0.06 to 0.82), respectively. Combining high CRP values (>80 mg/L) and elevated white blood cell (WBC) count provided specificity >85%, positive likelihood ratios >3, but sensitivity <46% for both radiographic proven and bacterial pneumonia.
  
  
  CONCLUSIONS
  With relatively high specificity and likelihood ratio CRP, WBC count and hypoxemia may be beneficial in ruling in a positive chest radiograph in suspected pneumonia and bacterial etiology in proven pneumonia, but with low sensitivity, the clinical utility is limited. What is Known: • Pneumonia is recommended to be a clinical diagnosis, and neither clinical features nor inflammatory markers can reliably distinguish etiology. • The etiology of pneumonia has changed after routine pneumococcal conjugate vaccine. What is New: • High CRP and WBC counts were associated with infiltrates in children with suspected pneumonia and with bacterial infection in proven pneumonia. • In the post-pneumococcal vaccination era, viral etiology is expected, and in cases of pneumonia with low CRP and WBC counts, a watch-and-wait strategy for antibiotic treatment may be applied.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postal Box 1000, 1478, Lørenskog, Norway. arebe@medisin.uio.no.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. arebe@medisin.uio.no.
authors.forename: Are Stuwitz
authors.initials: AS
authors.lastname: Berg
authors.affiliation: Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postal Box 1000, 1478, Lørenskog, Norway.
authors.forename: Christopher Stephen
authors.initials: CS
authors.lastname: Inchley
authors.affiliation: Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postal Box 1000, 1478, Lørenskog, Norway.
authors.forename: Hans Olav
authors.initials: HO
authors.lastname: Fjaerli
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Truls Michael
authors.initials: TM
authors.lastname: Leegaard
authors.affiliation: Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Lindbaek
authors.affiliation: Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postal Box 1000, 1478, Lørenskog, Norway.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Britt
authors.initials: B
authors.lastname: Nakstad
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D022242:Pneumococcal Vaccines / Q000276:immunology; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011024:Pneumonia, Viral / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012372:ROC Curve; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D022242:Pneumococcal Vaccines; D002097:C-Reactive Protein
keywords: Clinical features; Inflammatory markers; Pneumococcal vaccination; Pneumonia