Division of Emergency Medicine, 300 Longwood Ave, Boston, MA 02115.
Pediatrics. 2011 Aug;128(2):246-53. doi: 10.1542/peds.2010-3367. Epub 2011 Jul 11.
To study the association between historical and physical examination findings and radiographic pneumonia in children who present with suspicion for pneumonia in the emergency department, and to develop a clinical decision rule for the use of chest radiography.
We conducted a prospective cohort study in an urban pediatric emergency department of patients younger than 21 who had a chest radiograph performed for suspicion of pneumonia (n = 2574). Pneumonia was categorized into 2 groups on the basis of an attending radiologist interpretation of the chest radiograph: radiographic pneumonia (includes definite and equivocal cases of pneumonia) and definite pneumonia. We estimated a multivariate logistic regression model with pneumonia status as the dependent variable and the historical and physical examination findings as the independent variables. We also performed a recursive partitioning analysis.
Sixteen percent of patients had radiographic pneumonia. History of chest pain, focal rales, duration of fever, and oximetry levels at triage were significant predictors of pneumonia. The presence of tachypnea, retractions, and grunting were not associated with pneumonia. Hypoxia (oxygen saturation ≤92%) was the strongest predictor of pneumonia (odds ratio: 3.6 [95% confidence interval (CI): 2.0-6.8]). Recursive partitioning analysis revealed that among subjects with O₂ saturation >92%, no history of fever, no focal decreased breath sounds, and no focal rales, the rate of radiographic pneumonia was 7.6% (95% CI: 5.3-10.0) and definite pneumonia was 2.9% (95% CI: 1.4-4.4).
Historical and physical examination findings can be used to risk stratify children for risk of radiographic pneumonia.
研究在急诊科因疑似肺炎就诊的患儿中，病史和体格检查结果与放射影像学肺炎之间的关系，并制定放射影像学检查的临床决策规则。
我们对一家城市儿科急诊科进行了前瞻性队列研究，纳入了因疑似肺炎行胸部 X 线检查的年龄小于 21 岁的患者（n=2574）。根据主治放射科医生对胸部 X 线片的解读，将肺炎分为两组：放射影像学肺炎（包括明确和疑似肺炎病例）和明确肺炎。我们使用多变量逻辑回归模型，将肺炎状态作为因变量，病史和体格检查结果作为自变量进行分析。我们还进行了递归分割分析。
16%的患者存在放射影像学肺炎。胸痛史、局灶性啰音、发热持续时间和分诊时的血氧饱和度是肺炎的重要预测因素。呼吸急促、三凹征和呼噜声与肺炎无关。低氧血症（血氧饱和度≤92%）是肺炎最强的预测因素（比值比：3.6[95%置信区间（CI）：2.0-6.8]）。递归分割分析显示，在血氧饱和度＞92%的患者中，无发热史、无局灶性呼吸音减弱和无局灶性啰音的患者，放射影像学肺炎的发生率为 7.6%（95%CI：5.3-10.0），明确肺炎的发生率为 2.9%（95%CI：1.4-4.4）。
病史和体格检查结果可用于对患儿进行放射影像学肺炎风险分层。
