Division of Emergency Medicine, Children's Hospital Boston, Boston, Boston, MA 02115, USA.
Pediatr Infect Dis J. 2012 Jun;31(6):561-4. doi: 10.1097/INF.0b013e31824da716.
The World Health Organization (WHO) established guidelines that rely on simple clinical signs for the diagnosis of childhood pneumonia in resource-limited settings. Our objective was to evaluate the test characteristics of the WHO criteria for the diagnosis of radiographic pneumonia in the emergency department setting.
We prospectively collected clinical information from children ≤5 years of age presenting to a US-based pediatric emergency department who had a chest radiograph performed for suspicion of pneumonia. Patients were classified as meeting the WHO case definition of pneumonia if they had both 1) cough or difficulty breathing and 2) age-specific WHO-defined tachypnea. The primary outcome was radiographic pneumonia based on the final radiology report. Among children with cough or with difficulty breathing, receiver operator characteristic curve analysis was used to evaluate the test characteristics of triage respiratory rate, temperature and oxygen saturation for the diagnosis of radiographic pneumonia.
Two thousand eight children were enrolled. Median age was 19 months, and 28.5% had tachypnea based upon age-specific respiratory rate thresholds. Of the 324 children with radiographic pneumonia, 111 met the WHO case definition of pneumonia (sensitivity = 34.3%, 95% confidence interval: 29.1-39.7). Triage respiratory rate demonstrated an area under the curve of 0.54 for the diagnosis of radiographic pneumonia. The area under the curve for triage temperature and oxygen saturation was 0.56 and 0.60, respectively.
The WHO criteria demonstrated poor sensitivity for the diagnosis of radiographic pneumonia in a US-based pediatric emergency department. Compared with respiratory rate, oxygen saturation offered slightly improved test characteristics. Although applied to a different target population, these findings suggest the WHO criteria may not be a sensitive screening tool for the diagnosis of pneumonia in children.
世界卫生组织（WHO）制定了一些指南，这些指南依赖于简单的临床体征来诊断资源有限环境下的儿童肺炎。我们的目标是评估在急诊环境下，WHO 诊断肺炎的标准对放射学肺炎的诊断测试特性。
我们前瞻性地收集了美国儿科急诊就诊的≤5 岁儿童的临床信息，这些儿童因疑似肺炎而进行了胸部 X 光检查。如果患者符合以下两个条件，就会被归类为符合 WHO 肺炎病例定义：1）咳嗽或呼吸困难；2）年龄特定的 WHO 定义的呼吸急促。主要结局是根据最终放射学报告确定的放射学肺炎。对于有咳嗽或呼吸困难的儿童，采用受试者工作特征曲线分析评估分诊呼吸频率、体温和血氧饱和度对放射学肺炎的诊断测试特性。
共纳入了 2800 名儿童。中位年龄为 19 个月，28.5%的儿童根据年龄特定的呼吸率阈值出现呼吸急促。在 324 名患有放射学肺炎的儿童中，有 111 名符合 WHO 肺炎病例定义（敏感性=34.3%，95%置信区间：29.1-39.7）。分诊呼吸率对放射学肺炎的诊断的曲线下面积为 0.54。分诊体温和血氧饱和度的曲线下面积分别为 0.56 和 0.60。
在基于美国的儿科急诊中，WHO 标准对放射学肺炎的诊断敏感性较差。与呼吸率相比，血氧饱和度提供了稍微改善的测试特性。尽管应用于不同的目标人群，但这些发现表明 WHO 标准可能不是诊断儿童肺炎的敏感筛查工具。
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