Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis

Hypoxia and signs of increased work of breathing are most strongly associated with radiographic pneumonia in children

“…The lack of association with auscultatory signs may reflect the subjectivity and difficulty of reliably ascertaining such signs especially in young children. These findings are consistent with a prior meta-analysis of clinical predictors of radiological pneumonia of 18 paediatric studies 4. Measurement of oxygen saturation may also be useful not only for diagnosis but also to guide oxygen therapy as clinical signs are inaccurate for hypoxia 5.…”

Paediatric respiratory infections

“…A systematic review of a large number of papers addressing the utility of a wide range of signs in accurately identifying infants with pneumonia confirmed the well-established finding that no one sign or indeed combination of signs reliably identified infants with pneumonia [4]. As noted in an editorial [5], the World Health Organization (WHO) approach based on respiratory rate greatly overestimates the incidence of pneumonia, but was designed to ensure the early use of antibiotics in resource-poor countries to try and impact on the high levels of mortality.…”

Lung Ultrasonography: A Viable Alternative to Chest Radiography in Children with Suspected Pneumonia?

“…Clinical diagnosis of pneumonia is challenging and highly variable, and thus results in a poor reference standard for LUS. 26 The finding of interstitial disease with LUS had poor IRR, likely related to the lack of agreement in the literature regarding the number of B-lines needed to define true interstitial disease of the lung. Some previous studies have determined that the presence of 3 or more B-lines in a single view is valid indication of the diagnosis of interstitial disease; however, other studies did not quantify the exact numbers of Blines, but rather noted a significantly greater number in pathological lungs compared with healthy lungs.…”