Authors: Bilkis, Manuel D.; Gorgal, Nelly; Carbone, Miriam; Vazquez, Mirta; Albanese, Paulo; Branda, María Cecilia; Alterman, Elías; Rodriguez, Daniela Andrea; Orellana, Liliana; Bello Pedrosa, Osvaldo
Publication Date: 2010.
Objectives: To develop a mathematical model to predict the probability of having community-acquired pneumonia and to evaluate an already developed prediction rule that has not been validated in a clinical scenario. Methods: Children who presented with fever and had presumptive clinical diagnosis of pneumonia were evaluated in 4 institutions of different complexity during 1 year. The variables assessed were sex, age, respiratory rate, days with fever, maximum body temperature, presence of tachypnea, cough, chest pain, intercostal retraction, nasal flaring, abdominal pain, vomiting, grunting, rales, decreased breath sounds, wheezing, fatigue, loss of appetite, loss of sleep, and season of the year. The chest radiographs were photographed and then interpreted by 2 pediatric radiologists. Results: A total of 257 children were evaluated: 179 (69%) had clinical and radiological diagnosis of community-acquired pneumonia, and 78 (30%) had no radiological confirmation. A total of 96 photographs were recorded, and in 64 of the cases, there was agreement in the diagnosis between the evaluating pediatrician and the radiologists (J index = 0.68). With the calculated probabilities, it was possible to build a receiving operating characteristic curve and, based on the estimated coefficients we calculated, a value associated to the probability of having pneumonia. Conclusions: We developed a model including 5 variables of high level of sensitivity for the diagnosis of pneumonia. To use it, it would be useful to apply the appropriate software. In addition, we validated a clinical prediction rule of 4 variables that proved to have 93.8% sensitivity to diagnose pneumonia in children with a fever and localized rales, or decreased breath sounds, or tachypnea, or any combination of these 4 variables.
Author affiliation: Bilkis, Manuel D.. Hospital de Niños "Ricardo Gutiérrez"; Argentina
Author affiliation: Gorgal, Nelly. Centro Hospitalario "Pereira Rossell"; Uruguay
Author affiliation: Carbone, Miriam. Hospital de Agudos "Diego Paroissien"; Argentina
Author affiliation: Vazquez, Mirta. Policlínico del Docente; Argentina
Author affiliation: Albanese, Paulo. Hospital de Agudos "Enrique Tornú"; Argentina
Author affiliation: Branda, María Cecilia. Hospital de Niños "Ricardo Gutiérrez"; Argentina
Author affiliation: Alterman, Elías. Hospital de Niños "Ricardo Gutiérrez"; Argentina. Universidad de Buenos Aires; Argentina
Author affiliation: Rodriguez, Daniela Andrea. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Author affiliation: Orellana, Liliana. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Cálculo; Argentina
Author affiliation: Bello Pedrosa, Osvaldo. Universidad de la República; Uruguay
Repository: CONICET Digital (CONICET). Consejo Nacional de Investigaciones Científicas y Técnicas