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Pediatr Emerg Care. 2010 Nov;26(11):817-22. doi: 10.1097/PEC.0b013e3181fb0d95.

Physician assessment of the likelihood of pneumonia in a pediatric emergency department.

Author information

  • 1Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA. Mark.Neuman@childrens.harvard.edu

Abstract

BACKGROUND:

The value of physical examination findings in the diagnosis of pneumonia in children may be limited, and the accuracy of physicians in predicting pneumonia is not known.

OBJECTIVE:

We sought to determine the correlation between physicians' assessment of the likelihood of pneumonia and radiographic presence of pneumonia.

METHODS:

Prospective observational study of children 21 years or younger presenting to a pediatric emergency department, who had a chest radiography performed for suspicion of pneumonia. Physicians recorded clinical findings and likelihood of pneumonia before obtaining the radiograph. Definite and probable pneumonia was defined by a radiologist's interpretation of the radiograph.

RESULTS:

Of 2071 children, 147 (7%) had definite radiographic pneumonia, whereas 321 (15%) had probable or definite pneumonia. Among patients perceived to be at lowest risk for pneumonia (<5% prediction), 4.3% (95% confidence interval [CI], 2.9%-5.7%) had definite pneumonia, and 10.0% (95% CI, 8.3%-12.5%) had probable or definite pneumonia. Among children perceived to be at highest risk for pneumonia (>75% prediction), 30.6% (95% CI, 15.5%-45.6%) had definite pneumonia, and 52.8% (95% CI, 37.7%-70.3%) had probable or definite pneumonia. Physicians' estimates of the likelihood of pneumonia were positively correlated with the rate of definite (Spearman ρ = 0.15, P < 0.001) and probable or definite radiographic pneumonia (Spearman ρ = 0.19, P < 0.001).

CONCLUSIONS:

With some overestimation, physicians' assessment of the likelihood of pneumonia correlates well with radiographic diagnosis of pneumonia.

PMID:
20944506
[PubMed - indexed for MEDLINE]
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