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

  title={Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review},
  author={Sonal N. Shah and Richard G Bachur and David L. Simel and Mark I Neuman},
Importance Pneumonia is a leading cause of morbidity and mortality in children. [] Key Method 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.

Tables from this paper

Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review

Identifying a child with pneumonia in the large group of children with acute respiratory tract infections can be challenging for primary care physicians. Knowledge on the diagnostic value of specific

Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children

In children with suspected pneumonia, the novel Pneumonia Risk Score (PRS), a clinical tool utilizing signs and symptoms available to clinicians to determine a child’s risk of radiographic pneumonia, is superior to clinician judgment in predicting the presence of radiography.

An analysis of clinical predictive values for radiographic pneumonia in children

No single sign or symptom was strongly associated with radiographic primary end point pneumonia in children, and performance characteristics were improved by combining individual signs and symptoms.

Lung ultrasound in diagnosing pneumonia in childhood: a systematic review and meta-analysis

LUS seems to be a promise tool for diagnosing pneumonia in children, however, the high heterogeneity found across the individual studies, and the absence of a reliable reference standard, make the finding questionable.

Prospective evaluation of World Health Organization guidelines for diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting

The WHO criteria for diagnosis of pneumonia in children under 5 years of age presenting to an emergency department (ED) in Nepal had poor sensitivity and specificity.

Strategies for recognizing pneumonia look-alikes

Clinicians are provided with a series of questions to ask themselves in order to detect a possible differential diagnosis of pneumonia in children, illustrated by 13 real clinical cases in which a child was misdiagnosed as having lobar pneumonia.

Hypoxia and signs of increased work of breathing are most strongly associated with radiographic pneumonia in children

  • H. Zar
  • Medicine
    BMJ Evidence-Based Medicine
  • 2018
A systematic review of studies from 1956 to May 2017 of the accuracy of symptoms and clinical signs for diagnosis of paediatric pneumonia as defined by radiographic disease found that these signs are sensitive but non-specific.

Diagnostic accuracy of procalcitonin for bacterial pneumonia in children – a systematic review and meta-analysis

It is recommended that procalcitonin be used in conjunction with other findings for management and disposition of children with pneumonia, given the moderate diagnostic accuracy of procalCitonin for bacterial pneumonia.

Association of Clinical Signs, Host Biomarkers and Etiology With Radiological Pneumonia in Bhutanese Children

Clinical characteristics, host-response biomarkers and etiology are described, and their relationship to CXR findings in children with pneumonia in Thimphu, Bhutan is assessed, and markers of endothelial and immune activation had little accuracy for the reliable identification of radiological pneumonia.



Case Management of Childhood Pneumonia in Developing Countries

Issues that specifically need to be addressed are the adequacy of penicillin monotherapy, or oral amoxicillin or alternative antibiotics; the timing of introduction of high-dose trimethoprim-sulfamethoxazole in children at risk for or known to be infected by HIV and the value of pulse oximetry.

A Systematic Review on the Diagnosis of Pediatric Bacterial Pneumonia: When Gold Is Bronze

It is found that studies assessing the diagnostic accuracy of clinical, radiological, and laboratory tests for bacterial childhood pneumonia have used a heterogeneous group of gold standards, and found that index tests have widely different accuracies.

Diagnosis of Childhood Pneumonia: Clinical Assessment Without Radiological Confirmation May Lead to Overtreatment

Treatment of childhood pneumonia on the basis of clinical parameters alone with no chest x-ray confirmation may lead to a large portion of children receiving unnecessary antibiotic therapy.

Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana

Chest radiograph provides useful prognostic information for children meeting clinical criteria for pneumonia in Botswana, and the potential benefit of expanded global access to diagnostic radiology services is highlighted.

Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination.

Some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary.

Physician Assessment of the Likelihood of Pneumonia in a Pediatric Emergency Department

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

The Role of Physical Examination in Establishing the Diagnosis of Pneumonia

Results demonstrate the significant added value of chest radiography as an ancillary test for diagnosis of pneumonia in the emergency department setting and demonstrate the accuracy of medical history and physical examination in diagnosing CAP.

Does This Infant Have Pneumonia

The best individual finding for ruling out pneumonia is the absence of tachypnea, and studies are needed to assess the value of clinical findings when they are used together.

Comparison of the clinical and radiographic diagnosis of paediatric pneumonia.

Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

A retrospective review of clinical and laboratory data among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia shows high specificity for acute lower respiratory infection.