PubTransformer

A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review.

Abstract Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse.
PMID
Related Publications

Does this patient have influenza?

Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis.

Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.

Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review.

Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community-acquired pneumonia.

Authors

Mayor MeshTerms
Keywords
Journal Title jama
Publication Year Start




PMID- 28763554
OWN - NLM
STAT- In-Process
DA  - 20170801
LR  - 20170801
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 5
DP  - 2017 Aug 01
TI  - Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic
      Review.
PG  - 462-471
LID - 10.1001/jama.2017.9039 [doi]
AB  - Importance: Pneumonia is a leading cause of morbidity and mortality in children. 
      It is important to identify the clinical symptoms and physical examination
      findings associated with pneumonia to improve timely diagnosis, prevent
      significant morbidity, and limit antibiotic overuse. Objective: To systematically
      review the accuracy of symptoms and physical examination findings in identifying 
      children with radiographic pneumonia. Data Sources and Study Selection: MEDLINE
      and Embase (1956 to May 2017) were searched, along with reference lists from
      retrieved articles, to identify diagnostic studies of pediatric pneumonia across 
      a broad age range that had to include children younger than age 5 years (although
      some studies enrolled children up to age 19 years); 3644 unique articles were
      identified, of which 23 met inclusion criteria. Data Extraction and Synthesis:
      Two authors independently abstracted raw data and assessed methodological
      quality. A third author resolved disputes. Main Outcomes and Measures: Likelihood
      ratios (LRs), sensitivity, and specificity were calculated for individual
      symptoms and physical examination findings for the diagnosis of pneumonia. An
      infiltrate on chest radiograph was considered the reference standard for the
      diagnosis of pneumonia. Results: Twenty-three prospective cohort studies of
      children (N = 13833) with possible pneumonia were included (8 from North
      America), with a range of 78 to 2829 patients per study. The prevalence of
      radiographic pneumonia in North American studies was 19% (95% CI, 11%-31%) and
      37% (95% CI, 26%-50%) outside of North America. No single symptom was strongly
      associated with pneumonia; however, the presence of chest pain in 2 studies that 
      included adolescents was associated with pneumonia (LR, 1.5-5.5; sensitivity,
      8%-14%; specificity, 94%-97%). Vital sign abnormalities such as fever
      (temperature >37.5 degrees C [LR range, 1.7-1.8]; sensitivity, 80%-92%;
      specificity, 47%-54%) and tachypnea (respiratory rate >40 breaths/min; LR, 1.5
      [95% CI, 1.3-1.7]; sensitivity, 79%; specificity, 51%) were not strongly
      associated with pneumonia diagnosis. Similarly, auscultatory findings were not
      associated with pneumonia diagnosis. The presence of moderate hypoxemia (oxygen
      saturation </=96%; LR, 2.8 [95% CI, 2.1-3.6]; sensitivity, 64%; specificity, 77%)
      and increased work of breathing (grunting, flaring, and retractions; positive LR,
      2.1 [95% CI, 1.6-2.7]) were signs most associated with pneumonia. The presence of
      normal oxygenation (oxygen saturation >96%) decreased the likelihood of pneumonia
      (LR, 0.47 [95% CI, 0.32-0.67]). Conclusions and Relevance: Although no single
      finding reliably differentiates pneumonia from other causes of childhood
      respiratory illness, hypoxia and increased work of breathing are more important
      than tachypnea and auscultatory findings.
FAU - Shah, Sonal N
AU  - Shah SN
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts.
FAU - Bachur, Richard G
AU  - Bachur RG
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts.
FAU - Simel, David L
AU  - Simel DL
AD  - Durham Veterans Medical Center, Durham, North Carolina3Duke University, Durham,
      North Carolina.
FAU - Neuman, Mark I
AU  - Neuman MI
AD  - Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical
      School, Boston, Massachusetts.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
EDAT- 2017/08/02 06:00
MHDA- 2017/08/02 06:00
CRDT- 2017/08/02 06:00
AID - 2646723 [pii]
AID - 10.1001/jama.2017.9039 [doi]
PST - ppublish
SO  - JAMA. 2017 Aug 1;318(5):462-471. doi: 10.1001/jama.2017.9039.