Clinical data can be considered as risk factors predisposing to pneumonia in children
On the basis of the clinical picture, we can make an assumption about the risk of developing pneumonia in children hospitalized in the emergency department of pediatric care.
According to the results of a prospective cohort study published on July 11 in the online issue of Pediatrics, based on the clinical picture, we can make an assumption about the risk of developing pneumonia in children hospitalized in the pediatric emergency department.
According to a research team led by Mark I. Neuman (Children's Hospital, Boston, Massachusetts, Department of Emergency Medicine and Clinical Research Program), the possibility of using chest x-rays to assess the severity of children's conditions with an estimated diagnosis of pneumonia vary widely. And although many studies have identified specific anamnestic and physical data associated with pneumonia, none of them has raised the question of developing criteria for the need for a chest x-ray to clarify the diagnosis.
The objectives of this study were to: determine the relationship between medical history, physical examination and x-ray in children in the emergency department regarding the presumed diagnosis of pneumonia, and to develop a rule for deciding on the chest x-ray.
The cohort studied consisted of 2574 patients from the city's pediatric emergency department with a preliminary diagnosis of pneumonia under the age of 21, who were clinically examined and who underwent a chest X-ray.
Based on a specialist's interpretation of the results of the chest x-ray, the pneumonia was classified as confirmed or suspected radiologically.
Radiological pneumonia was present in 16% of the patients. Anamnestic indications of chest pain, local rales, duration of fever, and pulmonary oximetry were important predictors of pneumonia. The most significant criterion for the development of pneumonia was hypoxia, defined as oxygen saturation less than 92% (odds ratio 3.6, 95% confidence interval 2.0-6.8).
In patients with oxygen saturation greater than 92% and the absence of fever, local weakening of vesicular respiration or local rales, radiological pneumonia was detected in 7.6% of cases (confidence interval at 95% 5.3-10.0), the diagnosis of pneumonia was confirmed in 2.9% of the patients (95% confidence interval 1.4-4.4).
According to the authors of the study, based on the clinical picture of the disease, it becomes possible to stratify children into groups at risk of developing pneumonia. Children with hypoxia and local data are at high risk, while children without hypoxia, fever and auscultatory signs of pneumonia are at low risk. For this last category of patients, a clinical follow-up plan must be developed, taking into account the chest radiography data.
However, the researchers recognize that the results obtained during the study require a more advanced evidence base, which can be obtained after a multicenter study with a mandatory analysis of the reliability of the physical examination data.