Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

Abstract

Background: The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies.

Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners

“…The central goal of a case management algorithm is to identify children who need urgent treatment with antibiotics and its complications such as sepsis and empyema. Previous studies have shown that the WHO algorithm accuracy varies with the severity of the disease [11][12][13], which may explain the difference in diagnostic performance in Peru and Nepal. Combining the WHO algorithm with point-of-care ultrasound may increase pneumonia diagnosis specificity and sensitivity, shortening also the diagnosis-to-prescription time, thus potentially contributing to decreasing complications, mortality, antibiotic resistance, and costs of over-treating pneumonia cases.…”

“…When using this algorithm, children are classified as having pneumonia based on symptoms of coughing, shortness of breath, and elevated respiratory rate; and severity was defined according to the presence or absence of danger signs including chest indrawing, inability to feed, convulsions, lethargy, or stridor at rest [6]. The diagnostic accuracy the algorithm appeared to vary with nutritional status [7,8], age [9], high altitude [10], prevalence of non-severe pneumonia, and prevalence of wheezing [11][12][13]. The sensitivity of this algorithm has varied from 77 to 94 % and specificity from 39 to 98 % across multiple studies [7-10, 14, 15].…”

A Randomized Controlled Trial of Zinc as Adjuvant Therapy for Severe Pneumonia in Young Children

“…This definition has high specificity for severe lower respiratory tract infection but does not define the etiology. 23 Severe pneumonia includes a wide spectrum of causes and predisposing factors that may respond differently to zinc administration. Furthermore, this heterogeneity can also result in poor specificity of the outcomes, which again may dilute …”

Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: The need for pulse oximetry in case management

“…Manifestations of severe malaria considered in this study included: coma, defined by a Blantyre Coma Scale (BCS) score ≤2 for children less than 2 years of age or a Glasgow Coma Scale (GCS) score ≤9 for older children; prostration, defined as the inability to sit unsupported or the inability to drink or breast-feed in younger children; convulsions with a duration longer than 30 admission; severe respiratory distress, defined as flaring of alar nasi, subcostal or lower chest in-drawing, or use of accessory muscles, severe tachypnoea, or deep breathing; hypoglycaemia, defined as blood glucose <3 mmol/L or clinical improvement in the level of consciousness immediately after administration of 10% dextrose; severe anaemia, defined as haematocrit of less than 15%; passing of dark or "coca-cola" coloured urine; clinically demonstrable jaundice; hyperparasitaemia, defined as asexual parasitaemia greater than 250,000 per microlitre of blood and renal impairment was defined as urine output <12 ml/kg/24 hours and a serum creatinine >265 μmol/l (>3.0 mg/dl) despite adequate volume repletion. Pneumonia was defined by the presence of cough, fast breathing and chest wall in-drawing in a child with clinical auscultatory signs and they all had chest x-ray for confirmation 19,20 . Children who were unconscious, presented with convulsions or were critically ill were referred for radiography after their condition stabilized.…”