Detection of Occult Pneumonia in a Pediatric Emergency Department

Shah, Sonal; Mathews, Bonnie; Neuman, Mark I.; Bachur, Richard G.

doi:10.1097/pec.0b013e3181ef04a3

Cited by 14 publications

(5 citation statements)

References 20 publications

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“…This number is almost in line with the results of the present study (6). In the study by Shah et al to determine the predictive factors and incidence of latent pneumonia in patients who had undergone chest x-ray examination; out of 308 studied patients, 21 (6.8%) had latent pneumonia, which is almost in accordance with the results of present study (9). In the study by Bachur et al, 225 patients received chest x-ray examination.…”

Section: Discussionsupporting

confidence: 92%

“…In the present study, the mean WBC count in the bacterial pneumonia, viral infection, and other disease groups was reported 13.79×10³ ± 3.98×10³, 10.82×10³ ± 4.47×10³, and 11.97×10³ ±4.92×10³, respectively, showing no significant difference (P = 0.511). In the study by Shah et al, the mean WBC count in the latent pneumonia and non-pneumonia groups was reported 15.40×10³ and 17.60×10³, indicating no significant difference (P = 0.74) (9). In the research by Rutman et al, the mean WBC count in the pneumonia and non-pneumonia groups was 26.30×10³ and 24.10×10³, respectively (10), showing no significant difference, and being in line with the results of present study.…”

Section: Discussionmentioning

confidence: 90%

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Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

et al. 2021

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Background: Fever is one of the most common causes of children’s referral to the emergency department, for which in 20% of cases no clear source is found. Latent pneumonia is not easily differentiable as one of the differential diagnoses of fever of unknown origin (FUO). This study aimed to determine the relationship between FUO and latent pneumonia in feverish children referring to pediatric emergency department. Materials and Methods: The present analytical research was carried out on 220 children with FUO aged 3-36 months referred to pediatric hospital of Bandar Abbas, Iran in 2019. To find the signs and symptoms, demographic information, history, and physical examination results were recorded by a physician using a predetermined checklist. Chest x-ray and blood sample were prepared for white blood cell (WBC) count, C-reactive protein (CRP), and absolute neutrophil count (ANC). Results: The mean age of the patients was 18.38±8.6 months. There was no significant difference between the mean fever, pulse rate, respiratory rate, WBC count, erythrocyte sedimentation rate (ESR), and ANC among the three groups differentiated by their diagnosis. The mean CRP in the bacterial pneumonia group was 68.17±24.13, while it was 35.00±20.43 in the viral infection group and 35.71±26.20 in the group of other diseases; the difference was statistically significant (P=0.004). Conclusion: Although there was no significant difference between WBC, ANC, and ESR and latent pneumonia, there was a significant difference between CRP and latent pneumonia, whose value was larger in these patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

et al. 2021

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“…However, the challenge lies not only in identifying children with, for example, pneumonia among children with signs of a lower respiratory tract infection but rather in designating risk thresholds to all children with fever. Indeed, it has been shown that the incidence of radiographically proved pneumonia among children with fever without a clear focus is significant (5-9%),48 49 50 51 and was especially high in children with raised laboratory markers (13-18%) 4851 Besides, not only did our prediction model verify known predictors of pneumonia in children at increased risk of a lower respiratory tract infection, supporting the validity of our results,4 38 52 but perhaps more importantly it also simultaneously showed that the presence of these signs and symptoms was valuable for ruling out other SBIs.…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

Nijman

Vergouwe

Thompson

et al. 2013

BMJ

135

167

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Objective To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department.Design Prospective observational diagnostic study.Setting Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom.Participants Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein.Main outcome measures Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs.Results Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86).Conclusion A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections.

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“…We defined Pneumonia as a Chest X-Ray reported by a radiologist as definite or probable for a pneumonia ("Infiltrate", "consolidation" or "concerning for developing pneumonia") irrespective of microbiological results as these are low yield [19]. This definition reflects clinical practice.…”

Section: Definitionsmentioning

confidence: 99%

Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study

et al. 2020

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Background: It is not yet known how antibiotics may affect Serious Bacterial Infections (SBI). Our aim is to describe the presentation, management, and serious bacterial infections (SBI) of febrile children on or off antibiotics. Methods: Retrospective, cohort study of febrile Emergency Department patients, 0-36 months of age, at a single institution, between 2009and 2012. Results: Seven hundred fifty-three patients were included: 584 in the No-Antibiotics group and 169 (22%) in the Antibiotics group. Age and abnormal lung sounds were predictors for being on antibiotics (OR 2.00 [95% CI 1.23-3.25] and OR 1.04 [95% CI 1.02-1.06] respectively) while female gender, and lower temperatures were negative predictors (OR 0.68 [95%0.47-0.98] and OR 0.47 [95% CI 0.32-0.67] respectively). Antibiotics were prescribed by a physician 89% of the time; the most common one being Amoxicillin/Clavulanic Acid (39%). The antibiotic group got more blood tests (57% vs 45%) and Chest X-Rays (37% vs 25%). Overall, the percent of SBIs (and pneumonias) was statistically the same in both groups (6.5% in the No-antibiotic group VS 3.6%). Conclusions: Children presenting on antibiotics and off antibiotics were significantly different in their presentation and management, although the overall percentages of SBI were similar in each group. Further investigations into this subgroup of febrile children are needed.

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Detection of Occult Pneumonia in a Pediatric Emergency Department

Abstract: 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.

Cited by 14 publications

References 20 publications

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study

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