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 Vol. 22 No. 4, October 2009
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AAP Grand Rounds 22:38 (2009)
© 2009 American Academy of Pediatrics

EPIDEMIOLOGY

Clinical Predictors of Pneumonia in Wheezing Children

Source: Mathews B, Shah S, Cleveland RH, et al. Clinical predictors of pneumonia among children with wheezing. Pediatrics. 2009;124(1):e29–e36; doi:10.1542/peds.2008–2062[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.


PICO

Question: Among wheezing children presenting to an emergency department, what historical and clinical findings are associated with radiographic pneumonia?

Question type: Diagnosis

Study design: Prospective cohort study

 

To determine whether clinical features of children presenting with wheezing could be used to develop a clinical decision rule for when to order chest radiographs (CXR) to detect pneumonia, this prospective cohort study was conducted at the Children’s Hospital Boston emergency department (ED) from November 2006 through October 2007. Children ≤21 years old with wheezing were eligible if they had a CXR. Those with chronic respiratory illnesses other than asthma, predisposition for pneumonia (eg, sickle cell disease, immunosuppression), or concern for trauma or foreign body aspiration were excluded.

ED physicians completed forms about cough, fever, chest pain, abdominal pain, difficulty breathing, retractions, grunting, focally decreased breath sounds, crackles, wheezing, and response to asthma treatments during the ED visit. Medical records were reviewed for demographic information, past history, vital signs, disposition, and therapy. Presence of pneumonia was determined on the basis of CXRs . . . [Full Text of this Article]

Charles R. Woods, MD, MS, FAAP
University of Louisville, Louisville, KY