Predictors of Pneumonia in Peds ED

•Prospective cohort study in urban peds ED with 2574 patients < 21 years old (most < 5 years old)

•Looked at history and physical exam findings that correlated with radiographic (i.e. CXR) pneumonia (PNA)

•16% of patients had radiographic PNA

•Significant predictors of PNA

• chest pain
• focal rales
• fever > 72 hours
• O2 sat < 92%

•Limits of study: not blinded, did not study all patient with cough or fever, do not know reliability of physical exam findings, did not include children who had suspected PNA but did not get a CXR

•Take home: There is not a great clinical prediction rule for whether to get CXR on kids with respiratory complaints and fever.

•Best of a bad situation: Single best predictor of radiographic PNA in kids < 5 = O2 sat < 92%

Submitted by F. DiFranco.

Reference(s): Neuman M.I., Monuteaux M.C., ScullyK.J., Bachur R.G. Prediction of pneumonia in a pediatric emergency department. Pediatrics.128(2):246-253, 2011; picture