Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
University of Melbourne, Melbourne, Victoria, Australia.
J Glob Health. 2022 Mar 26;12:10002. doi: 10.7189/jogh.12.10002. eCollection 2022.
Childhood pneumonia presents a large global burden, though most data and guidelines focus on children less than 5 years old. Less information is available about the clinical presentation of pneumonia in children 5-9 years of age. Appropriate diagnostic and treatment algorithms may differ from those applied to younger children. This systematic literature review aimed to identify clinical features of pneumonia in children aged 5-9 years, with a focus on delineation from other age groups and comparison with existing WHO guidance for pneumonia in children less than 5 years old.
We searched MEDLINE, EMBASE and PubMed databases for publications that described clinical features of pneumonia in children 5-9 years old, from any country with no date restriction in English. The quality of included studies was evaluated using a modified Effective Public Health Project Practice (EPHPP) tool. Data relating to research context, study type, clinical features of pneumonia and comparisons with children less than 5 years old were extracted. For each clinical feature of pneumonia, we described mean percentage (95% confidence interval) of participants with this finding in terms of aetiology (all cause vs ), and method of diagnosis (radiological vs clinical).
We included 15 publications, eight addressing all-cause pneumonia and seven addressing . Cough and fever were common in children aged 5-9 years with pneumonia. Tachypnoea was documented in around half of patients. Dyspnoea/difficulty breathing and chest indrawing were present in approximately half of all-cause pneumonia cases, with no data on indrawing in the outpatient setting. Chest and abdominal pain were documented in around one third of cases of all-cause pneumonia, based on limited numbers. In addition to markers of pneumonia severity used in children <5 years, pallor has been identified as being associated with poorer outcomes alongside comorbidities and nutritional status.
Quality research exploring clinical features of pneumonia, treatment and outcomes in children aged 5-9 years using consistent inclusion criteria, definitions of features and age ranges are urgently needed to better inform practice and guidelines. Based on limited data fever and cough are common in this age group, but tachypnoea cannot be relied on for diagnosis. While waiting for better evidence, broader attention to features such as chest and abdominal pain, the role of chest radiographs for diagnosis in the absence of symptoms such as tachypnoea, and risk factors which may influence patient disposition (chest indrawing, pallor, nutritional status) warrant consideration by clinicians.
PROSPERO: CRD42020213837.
儿童肺炎在全球造成了巨大负担，尽管大多数数据和指南都集中在 5 岁以下的儿童上。关于 5-9 岁儿童肺炎的临床表现，信息较少。适当的诊断和治疗方案可能与适用于年幼儿童的方案不同。本系统文献综述旨在确定 5-9 岁儿童肺炎的临床特征，重点是区分其他年龄组，并与世界卫生组织（WHO）针对 5 岁以下儿童肺炎的现有指南进行比较。
我们检索了 MEDLINE、EMBASE 和 PubMed 数据库，以查找描述来自任何国家的 5-9 岁儿童肺炎临床特征的英文出版物，无时间限制。使用改良的有效公共卫生实践项目（EPHPP）工具评估纳入研究的质量。提取与研究背景、研究类型、肺炎临床特征以及与 5 岁以下儿童比较相关的数据。对于肺炎的每一个临床特征，我们描述了根据病因（所有原因与 ）和诊断方法（影像学与临床），具有该特征的参与者的平均百分比（95%置信区间）。
我们纳入了 15 篇文献，其中 8 篇涉及所有原因肺炎，7 篇涉及 。咳嗽和发热在 5-9 岁患有肺炎的儿童中很常见。大约一半的患者存在呼吸急促。呼吸困难/呼吸急促和胸部凹陷在所有原因肺炎病例中约占一半，门诊病例中无凹陷数据。根据有限数量的病例，大约三分之一的所有原因肺炎病例记录了胸痛和腹痛。除了 5 岁以下儿童肺炎严重程度的标志物外，苍白已被确定与合并症和营养状况一样与不良结局相关。
迫切需要使用一致的纳入标准、特征定义和年龄范围，对 5-9 岁儿童肺炎的临床特征、治疗和结局进行高质量的研究，以更好地为实践和指南提供信息。基于有限的数据，发热和咳嗽在该年龄组中很常见，但不能依赖呼吸急促进行诊断。在等待更好的证据的同时，更广泛地关注胸痛和腹痛等特征，以及在没有呼吸急促等症状的情况下胸部 X 光片对诊断的作用，以及可能影响患者处置（胸部凹陷、苍白、营养状况）的风险因素，都值得临床医生考虑。
PROSPERO：CRD42020213837。
