Severe pneumonia in children under 5 years of age continues to be an important clinical entity with treatment failure rates as high as 20%. Where severe pneumonias are common, predictive tools for treatment failure like chest radiography and pulse oximetry are not available or affordable. Thus, there is a need for development of simple, accurate and inexpensive clinical tools for prediction of treatment failure. Using clinical, chest radiographic and pulse oximetry data from 1702 children recruited in the Amoxicillin Penicillin Pneumonia International Study (APPIS) trial we developed and validated a simple clinical tool. For development, a randomly derived development sample (n = 889) was used. The tool which was based on the results of multivariate logistic regression models was validated on a separate sample of 813 children. The derived clinical tool in its final form contained three clinical predictors: age of child, excess age-specific respiratory rate at baseline and at 24 hr of hospitalization. This tool had a 70% and 66% predictive accuracy in the development and validation samples, respectively. The tool is presented as an easy-to-use nomogram. It is possible to predict the likelihood of treatment failure in children with severe pneumonia based on clinical features that are simple and inexpensive to measure.

(c) 2009 Wiley-Liss, Inc.