Title
Detection of occult pneumonia in a pediatric emergency department
UMMS Affiliation
Department of Pediatrics
Publication Date
2010-09-02
Document Type
Article
Subjects
Child, Preschool; Female; Follow-Up Studies; Humans; Incidence; *Intensive Care Units, Pediatric; Male; Pneumonia; Predictive Value of Tests; Prospective Studies; Questionnaires; Radiography, Thoracic; United States
Disciplines
Emergency Medicine | Pediatrics
Abstract
BACKGROUND: Many children undergo chest radiography (CXR) in their evaluation of a febrile illness. Pneumonia without signs of respiratory distress or ausculatory findings has been previously described (termed occult pneumonia [OP]).
OBJECTIVE: The objectives of this study were to determine the incidence of OP among children who have CXR performed and to identify clinical predictors of OP.
METHODS: A prospective observational study of children undergoing CXR for possible pneumonia was conducted. Standardized data forms were completed before the CXR. Univariate analysis and recursive partitioning were used to identify predictors of OP.
RESULTS: Of 1866 patients enrolled, 308 had no evidence of respiratory distress or lower respiratory tract findings and were studied for OP. Twenty-one patients had radiographic OP (6.8%; 95% confidence interval [CI], 4.0%-10.6%). Age, height of fever, duration or quality of cough, and pulse oximetry were not associated with OP. A decision rule based on fever for 1 day or longer or with a combination of fever for less than 1 day but worsening cough identifies patients at greater risk for OP (likelihood ratio, 1.47; 95% CI, 1.21-1.77). No patient with fever for less than 1 day and without any cough or without worsening cough had pneumonia (likelihood ratio, 0.40; 95% CI, 0.19-0.84).
CONCLUSIONS: Occult pneumonia was identified in 1 of 15 patients undergoing CXR without respiratory distress or ausculatory findings. Obtaining a CXR for the detection of OP in children without cough and with fever for less than 1 day in duration should be discouraged.
DOI of Published Version
10.1097/PEC.0b013e3181ef04a3
Source
Pediatr Emerg Care. 2010 Sep;26(9):615-21. Link to article on publisher's site
Journal/Book/Conference Title
Pediatric emergency care
Related Resources
PubMed ID
20805779
Repository Citation
Shah, Sonal; Mathews, Bonnie L.; Neuman, Mark I.; and Bachur, Richard G., "Detection of occult pneumonia in a pediatric emergency department" (2010). Emergency Medicine. 7.
https://escholarship.umassmed.edu/peds_emergency/7