Application of the World Health Organization Criteria to Predict Radiographic Pneumonia in a US-based Pediatric Emergency Department

Wingerter, Sarah L.; Bachur, Richard G.; Monuteaux, Michael C.; Neuman, Mark I.

doi:10.1097/inf.0b013e31824da716

Cited by 41 publications

(23 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17 In contrast, the WHO case definition had a specificity of 78% in more than 1,300 children in Malawi, while the specificity was 74% among children presenting to an emergency department in the United States. 35, 36 Consistent with these latter studies, we observed primary endpoint pneumonia or other (non-end-point) infiltrates on chest radiograph in 76% of children identified using WHO clinical criteria. The conflicting results across studies may reflect differences in the study populations, variable application of the WHO case definition, or variation in the interpretation of chest radiographs.…”

Section: Discussionsupporting

confidence: 81%

Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana

Kelly¹,

Crotty

Rattan

et al. 2016

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

Background Chest radiography is increasingly used to diagnose pneumonia in low- and middle-income countries. Few studies examined whether chest radiographic findings predict outcomes of children with clinically suspected pneumonia in these settings. Methods Hospital-based, prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia in Botswana. Chest radiographs were reviewed by two pediatric radiologists to generate a consensus interpretation using standardized World Health Organization criteria. We assessed whether final chest radiograph classification was associated with our primary outcome, treatment failure at 48 hours, and secondary outcomes. Results From April 2012 to November 2014, we enrolled 249 children with evaluable chest radiographs. Median age was 6.1 months and 58% were male. Chest radiograph classifications were primary end-point pneumonia (35%), other infiltrate/abnormality (42%), or no significant pathology (22%). The prevalence of end-point consolidation was higher in children with HIV infection (P=0.0005), while end-point pleural effusions were more frequent among children with moderate or severe malnutrition (P=0.0003). Ninety-one (37%) children failed treatment and 12 (4.8%) children died. Primary end-point pneumonia was associated with an increased risk of treatment failure at 48 hours (P=0.002), a requirement for more days of respiratory support (P=0.002), and a longer length of stay (P=0.0003) compared with no significant pathology. Primary end-point pneumonia also predicted a higher risk of treatment failure than other infiltrate/abnormality (P=0.004). Conclusions Chest radiograph provides useful prognostic information for children meeting clinical criteria for pneumonia in Botswana. These findings highlight the potential benefit of expanded global access to diagnostic radiology services.

show abstract

Section: Discussionsupporting

confidence: 81%

Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana

Kelly¹,

Crotty

Rattan

et al. 2016

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

show abstract

“…A recent study of lung aspirates in children with CAP in the Gambia showed S. pneumoniae in 90% of the samples, yet this was prior to introduction of PCV and most detected pneumococci were serotypes included in the PCV 35. They did not find any hMPV which might indicate that the aetiology of CAP in high- and low-income countries differ 10. This is further supported by the low detection rate of hMPV (3%) in the study by Berkley et al 5 on Kenyan children with severe CAP.…”

Section: Discussionmentioning

confidence: 89%

“…Moreover, childhood CAP is difficult to diagnose. The Integrated Management of Childhood Illness (IMCI) diagnostic guidelines for the clinical diagnosis of CAP, developed by the WHO, have been important to reduce mortality, yet they lack sensitivity and specificity and might introduce misclassification bias in epidemiological studies 10. The gold standard today is diagnosis based on radiographic findings, which is the preferred method of case definition in epidemiological studies 11…”

Section: Introductionmentioning

confidence: 99%

Respiratory viruses associated with community-acquired pneumonia in children: matched case–control study

Rhedin

Lindstrand

Hjelmgren

et al. 2015

Thorax

122

133

View full text Add to dashboard Cite

“…Recent studies conducted in US emergency departments have shown that WHO criteria used to diagnose radiological pneumonia lack sensitivity and specificity [42] and that tachypnea did not discriminate between children with positive and negative chest X-ray [43]. In a systematic review and meta-analysis, fast breathing and lower chest wall indrawing showed poor diagnostic performance [44].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of clinical and laboratory features for the main febrile diseases in children living in Tanzania: A prospective observational study

et al. 2017

View full text Add to dashboard Cite

BackgroundTo construct evidence-based guidelines for management of febrile illness, it is essential to identify clinical predictors for the main causes of fever, either to diagnose the disease when no laboratory test is available or to better target testing when a test is available. The objective was to investigate clinical predictors of several diseases in a cohort of febrile children attending outpatient clinics in Tanzania, whose diagnoses have been established after extensive clinical and laboratory workup.MethodFrom April to December 2008, 1005 consecutive children aged 2 months to 10 years with temperature ≥38°C attending two outpatient clinics in Dar es Salaam were included. Demographic characteristics, symptoms and signs, comorbidities, full blood count and liver enzyme level were investigated by bi- and multi-variate analyses (Chan, et al., 2008). To evaluate accuracy of combined predictors to construct algorithms, classification and regression tree (CART) analyses were also performed.Results62 variables were studied. Between 4 and 15 significant predictors to rule in (aLR+>1) or rule out (aLR+<1) the disease were found in the multivariate analysis for the 7 more frequent outcomes. For malaria, the strongest predictor was temperature ≥40°C (aLR+8.4, 95%CI 4.7–15), for typhoid abdominal tenderness (5.9,2.5–11), for urinary tract infection (UTI) age ≥3 years (0.20,0–0.50), for radiological pneumonia abnormal chest auscultation (4.3,2.8–6.1), for acute HHV6 infection dehydration (0.18,0–0.75), for bacterial disease (any type) chest indrawing (19,8.2–60) and for viral disease (any type) jaundice (0.28,0.16–0.41). Other clinically relevant and easy to assess predictors were also found: malaria could be ruled in by recent travel, typhoid by jaundice, radiological pneumonia by very fast breathing and UTI by fever duration of ≥4 days.The CART model for malaria included temperature, travel, jaundice and hepatomegaly (sensitivity 80%, specificity 64%); typhoid: age ≥2 years, jaundice, abdominal tenderness and adenopathy (46%,93%); UTI: age <2 years, temperature ≥40°C, low weight and pale nails (20%,96%); radiological pneumonia: very fast breathing, chest indrawing and leukocytosis (38%,97%); acute HHV6 infection: less than 2 years old, (no) dehydration, (no) jaundice and (no) rash (86%,51%); bacterial disease: chest indrawing, chronic condition, temperature ≥39.7°c and fever duration >3 days (45%,83%); viral disease: runny nose, cough and age <2 years (68%,76%).ConclusionA better understanding of the relative performance of these predictors might be of great help for clinicians to be able to better decide when to test, treat, refer or simply observe a sick child, in order to decrease morbidity and mortality, but also to avoid unnecessary antimicrobial prescription. These predictors have been used to construct a new algorithm for the management of childhood illnesses called ALMANACH.

show abstract

Application of the World Health Organization Criteria to Predict Radiographic Pneumonia in a US-based Pediatric Emergency Department

Cited by 41 publications

References 12 publications

Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana

Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana

Respiratory viruses associated with community-acquired pneumonia in children: matched case–control study

Predictive value of clinical and laboratory features for the main febrile diseases in children living in Tanzania: A prospective observational study

Contact Info

Product

Resources

About