Department of Epidemiology, University of São Paulo, Brazil.
Arch Dis Child. 2011 Jan;96(1):58-61. doi: 10.1136/adc.2010.189894. Epub 2010 Sep 23.
To examine the ability of the criteria proposed by the WHO to identify pneumonia among cases presenting with wheezing and the extent to which adding fever to the criteria alters their performance.
Prospective classification of 390 children aged 2-59 months with lower respiratory tract disease into five diagnostic categories, including pneumonia. WHO criteria for the identification of pneumonia and a set of such criteria modified by adding fever were compared with radiographically diagnosed pneumonia as the gold standard.
The sensitivity of the WHO criteria was 94% for children aged <24 months and 62% for those aged ≥24 months. The corresponding specificities were 20% and 16%. Adding fever to the WHO criteria improved specificity substantially (to 44% and 50%, respectively). The specificity of the WHO criteria was poor for children with wheezing (12%). Adding fever improved this substantially (to 42%). The addition of fever to the criteria apparently reduced their sensitivity only marginally (to 92% and 57%, respectively, in the two age groups).
The authors' results reaffirm that the current WHO criteria can detect pneumonia with high sensitivity, particularly among younger children. They present evidence that the ability of these criteria to distinguish between children with pneumonia and those with wheezing diseases might be greatly enhanced by the addition of fever.
检验世卫组织提出的标准在识别有喘息症状的病例中的肺炎能力，以及添加发热标准后对其性能的影响程度。
前瞻性分类 390 名 2-59 月龄下呼吸道疾病患儿，分为五个诊断类别，包括肺炎。将世卫组织肺炎识别标准和一组通过添加发热修改的标准与放射学诊断肺炎作为金标准进行比较。
世卫组织标准对<24 月龄儿童的敏感性为 94%，对≥24 月龄儿童的敏感性为 62%。相应的特异性分别为 20%和 16%。将发热添加到世卫组织标准中可显著提高特异性（分别为 44%和 50%）。世卫组织标准对喘息患儿的特异性较差（12%）。添加发热可显著提高该特异性（分别为 42%）。将发热添加到标准中显然仅略微降低其敏感性（在两个年龄组中分别为 92%和 57%）。
作者的结果再次证实，目前的世卫组织标准可以非常高的敏感性检测肺炎，特别是在年幼儿童中。这些标准区分肺炎和喘息疾病患儿的能力可能通过添加发热标准得到极大提高。
