Decision rule to predict pneumonia in children presented with acute febrile respiratory illness
| Autor: | Kin Ming Poon, Chun Tat Lui, C.F. Tse, Fiona Y.Y. Chan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Fever Rhinorrhea Physical examination Clinical prediction rule Logistic regression 03 medical and health sciences 0302 clinical medicine Clinical Decision Rules Humans Medicine Child Hypoxia Lung Physical Examination Respiratory Sounds Tachypnea Respiratory distress medicine.diagnostic_test business.industry Infant Newborn Infant 030208 emergency & critical care medicine Pneumonia General Medicine Odds ratio Emergency department medicine.disease Chills Community-Acquired Infections Dyspnea Logistic Models Cough Child Preschool Emergency medicine Emergency Medicine Female Radiography Thoracic Nasal Obstruction business Chest radiograph |
| Zdroj: | The American Journal of Emergency Medicine. 38:2557-2563 |
| ISSN: | 0735-6757 |
| Popis: | It is a frequent challenge for physicians to identify pneumonia in patients with acute febrile respiratory symptoms, particularly in stable pediatric patients without respiratory distress. A decision rule is required to assist judgement on the need of ordering a chest radiograph.This was a multicenter prospective study in 3 emergency departments. Children younger than 6 years old with an acute onset of fever and respiratory symptoms were recruited. Split sample method was adopted for derivation and validation of the Pediatric Acute Febrile Respiratory Illness rule (PAFRI Rule). PAFRI was derived from logistic regression with weighting based on adjusted odds ratios.Out of 967 children evaluated, 530 had taken chest radiograph examination, with 91 demonstrated evidence of pneumonia on radiograph. PAFRI Rule was derived from logistic regression with 5 weighed predictors: duration of fever3 days (0 points), 3-4 days (2 points), 5-6 days (4 points), ≥7 days (5 points), chills (2 points), nasal symptoms (-2 points), abnormal chest examination (3 points), SpOPAFRI rule can be used as a reference tool for guiding the need for taking Chest radiograph examination for pediatric patients. While promising, the PAFRI rule requires further validation.It is often a challenge for physicians to identify pneumonia in children acutely febrile with respiratory symptoms, particularly in those who are stable without respiratory distress. The decision to order chest radiograph was based on clinical assessment with heterogenous practice. A valid and verified clinical prediction rule for ordering chest radiograph examination for stable febrile children without signs of respiratory distress would therefore assist in management of this group of patients.The PAFRI rule, based on parameters from clinical bedside assessment, can be used as a reference tool for guiding the need for referral to emergency department or taking use of chest radiograph for pediatric patients, and triaging for higher priority of clinical care. |
| Databáze: | OpenAIRE |
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