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Can We Predict Which Children With Clinically Suspected Pneumonia Will Have the Presence of Focal Infiltrates on Chest Radiographs?

Tim Lynch, MD^*, Robert Platt, PhD^,, Serge Gouin, MDCM^||, Charles Larson, MD^,,¶ and Yves Patenaude, MD^#

^* Department of Pediatrics, Children’s Hospital of Western Ontario, London, Ontario, Canada
Departments of Epidemiology
Biostatistics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
^|| Department of Pediatrics, Ste-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
^¶ Departments of Pediatrics
^# Radiology, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

Objective. To determine predictive factors for the presence of focal infiltrates in children with clinically suspected pneumonia in a pediatric emergency department.

Methods. Children (1–16 years) with clinically suspected pneumonia were studied prospectively. The presenting features were compared between the children with and without focal infiltrates using ² analysis, t test, and odds ratio with 95% confidence intervals. A multivariate prediction rule was developed using logistic regression.

Results. A total of 570 were studied. Risk factors (odds ratio; 95% confidence interval) for the presence of focal infiltrates included history of fever (3.1; 1.7–5.3), decreased breath sounds (1.4; 1.0–2.0), crackles (2.0; 1.4–2.9), retractions (2.8; 1.0–7.6), grunting (7.3; 1.1–48.1), fever (1.5; 1.2–1.9), tachypnea (1.8; 1.3–2.5), and tachycardia (1.3; 1.0–1.6). We then used logistic regression to develop a candidate prediction rule for the variables of fever, decreased breath sounds, crackles, and tachypnea, which had an area under the receiver operating curve of 0.668. This rule had excellent sensitivity (93.1%–98%) yet poor specificity (5.7%–19.4%).

Conclusions. Multiple predictive factors for children with suspected pneumonia have been identified. Patients with focal infiltrates were more likely in our study to have a history of fever, tachypnea, increased heart rate, retractions, grunting, crackles, or decreased breath sounds. A multivariate prediction rule shows promise for the accurate prediction of pneumonia in children. However, the prospective evaluation of this multivariate prediction rule in a clinical setting is still required.

Key Words: pneumonia • chest radiographs • children • predictive factors

Abbreviations: ED, emergency department • OR, odds ratio • CI, confidence interval

This article has been cited by other articles:

				J. Roukema, E. W. Steyerberg, J. van der Lei, and H. A. Moll Randomized Trial of a Clinical Decision Support System: Impact on the Management of Children with Fever without Apparent Source J. Am. Med. Inform. Assoc., January 1, 2008; 15(1): 107 - 113. [Abstract] [Full Text] [PDF]

				J. E Clark, D. Hammal, D. Spencer, and F. Hampton Children with pneumonia: how do they present and how are they managed? Arch. Dis. Child., May 1, 2007; 92(5): 394 - 398. [Abstract] [Full Text] [PDF]

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