Caregiver Assessment of Wheeze for Pediatric Pneumonia

Fox, Sean R.; Lipsett, Susan C.; Neuman, Mark I.

doi:10.1177/0009922819839242

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…10,11 Wheezing was included only as an examination finding rather than a historical symptom given the knowledge that parental report of wheeze is unreliable. 12 Fever was coded as a composite variable defined as a report of fever at home or temperature ≥38°C in the ED. Patient age and triage oxygen saturation were treated as continuous variables and the remaining variables as categorical variables.…”

Section: Statistical Analysesmentioning

confidence: 99%

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children

Lipsett

Hirsch

Monuteaux

et al. 2021

Pediatric Infectious Disease Journal

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Background:The diagnosis of pneumonia in children is challenging, given the wide overlap of many of the symptoms and physical examination findings with other common respiratory illnesses. We sought to derive and validate the novel Pneumonia Risk Score (PRS), a clinical tool utilizing signs and symptoms available to clinicians to determine a child's risk of radiographic pneumonia. Methods: We prospectively enrolled children 3 months to 18 years in whom a chest radiograph (CXR) was obtained in the emergency department to evaluate for pneumonia. Before CXR, we collected information regarding symptoms, physical examination findings, and the physician-estimated probability of radiographic pneumonia. Logistic regression was used to predict the presence of radiographic pneumonia, and the PRS was validated in a distinct cohort of children with suspected pneumonia. Results: Among 1181 children included in the study, 206 (17%) had radiographic pneumonia. The PRS included age in years, triage oxygen saturation, presence of fever, presence of rales, and presence of wheeze. The area under the curve (AUC) of the PRS was 0.71 (95% confidence interval [CI]: 0.68-0.75), while the AUC of clinician judgment was 0.61 (95% CI: 0.56-0.66) (P < 0.001). Among 2132 children included in the validation cohort, the PRS demonstrated an AUC of 0.69 (95% CI: 0.65-0.73). Conclusions: In children with suspected pneumonia, the PRS is superior to clinician judgment in predicting the presence of radiographic pneumonia. Use of the PRS may help efforts to support the judicious use of antibiotics and chest radiography among children with suspected pneumonia.

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Section: Statistical Analysesmentioning

confidence: 99%

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children

Lipsett

Hirsch

Monuteaux

et al. 2021

Pediatric Infectious Disease Journal

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“…We read with interest “Caregiver Assessment of Wheeze for Pediatric Pneumonia.” 1 We noted the number of children with wheeze sent for chest X-ray (CXR) and wish to present data from an urgent care network showing the high prevalence of infiltrate on CXR in children with few of the hallmarks of community-acquired pneumonia (CAP).…”

mentioning

confidence: 99%

Radiography in the Evaluation of Pediatric Pneumonia

Scheier

Zimmerman

2019

Clin Pediatr (Phila)

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Impact of Viral Radiographic Features on Antibiotic Treatment for Pediatric Pneumonia

Geanacopoulos

Lipsett

Hirsch

et al. 2022

Journal of the Pediatric Infectious Diseases Society

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Background/Objectives Chest radiograph (CXR) is routinely performed among children with suspected pneumonia, though it is not clear how specific radiographic findings impact antibiotic treatment for pneumonia. We evaluated the impact of viral radiographic features on antibiotic treatment among children undergoing pneumonia evaluation in the emergency department (ED). Methods Children presenting to a pediatric ED who underwent a CXR for pneumonia evaluation were prospectively enrolled. Prior to CXR performance, physicians indicated their level of suspicion for pneumonia. The CXR report was reviewed to assess for the presence of viral features (peribronchial cuffing, perihilar markings, and interstitial infiltrate) as well as radiographic features suggestive of pneumonia (consolidation, infiltrate, and opacity). The relationship between viral radiographic features and antibiotic treatment was assessed based on the level of clinical suspicion for pneumonia prior to CXR. Results Patients with normal CXRs (n = 400) and viral features alone (n = 370) were managed similarly, with 8.0% and 8.6% of patients receiving antibiotic treatment, respectively (P = .75). Compared with children with radiographic pneumonia (n = 174), patients with concurrent viral features and radiographic pneumonia (n = 177) were treated with antibiotics less frequently (86.2% vs 54.3%, P < .001). Among children with isolated viral features on CXR, antibiotic treatment rates were correlated with pre-CXR level of suspicion for pneumonia. Conclusions Among children with suspected pneumonia, the presence of viral features alone on CXR is not associated with increased rates of antibiotic use. Among children with radiographic pneumonia, the addition of viral features on CXR is associated with lower rates of antibiotic use, as compared to children with radiographic pneumonia alone.

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Caregiver Assessment of Wheeze for Pediatric Pneumonia

Cited by 3 publications

References 3 publications

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children

Radiography in the Evaluation of Pediatric Pneumonia

Impact of Viral Radiographic Features on Antibiotic Treatment for Pediatric Pneumonia

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