Title
Clinical predictors of pneumonia among children with wheezing
UMMS Affiliation
Department of Pediatrics
Publication Date
2009-07-01
Document Type
Article
Subjects
Abdominal Pain; Adolescent; Bronchiolitis; Child; Child, Preschool; Emergency Service, Hospital; Female; Fever; Humans; Infant; Male; Odds Ratio; Oxygen; Pneumonia; Prospective Studies; *Respiratory Sounds; Young Adult
Disciplines
Emergency Medicine | Pediatrics
Abstract
OBJECTIVE:
The goal was to identify factors associated with radiographically confirmed pneumonia among children with wheezing in the emergency department (ED) setting.
METHODS:
A prospective cohort study was performed with children
RESULTS:
A total of 526 patients met the inclusion criteria; the median age was 1.9 years (interquartile range: 0.7-4.5 years), and 36% were hospitalized. A history of wheezing was present for 247 patients (47%). Twenty-six patients (4.9% [95% confidence interval [CI]: 3.3-7.3]) had radiographic pneumonia. History of fever at home (positive likelihood ratio [LR]: 1.39 [95% CI: 1.13-1.70]), history of abdominal pain (positive LR: 2.85 [95% CI: 1.08-7.54]), triage temperature of >or=38 degrees C (positive LR: 2.03 [95% CI: 1.34-3.07]), maximal temperature in the ED of >or=38 degrees C (positive LR: 1.92 [95% CI: 1.48-2.49]), and triage oxygen saturation of <92% (positive LR: 3.06 [95% CI: 1.15-8.16]) were associated with increased risk of pneumonia. Among afebrile children (temperature of <38 degrees C) with wheezing, the rate of pneumonia was very low (2.2% [95% CI: 1.0-4.7]).
CONCLUSIONS:
Radiographic pneumonia among children with wheezing is uncommon. Historical and clinical factors may be used to determine the need for chest radiography for wheezing children. The routine use of chest radiography for children with wheezing but without fever should be discouraged.
DOI of Published Version
10.1542/peds.2008-2062
Source
Pediatrics. 2009 Jul;124(1):e29-36. Link to article on publisher's site
Journal/Book/Conference Title
Pediatrics
Related Resources
PubMed ID
19564266
Repository Citation
Mathews, Bonnie L.; Shah, Sonal; Cleveland, Robert H.; Lee, Edward Y.; Bachur, Richard G.; and Neuman, Mark I., "Clinical predictors of pneumonia among children with wheezing" (2009). Emergency Medicine. 6.
https://escholarship.umassmed.edu/peds_emergency/6