Building a Prediction Model for Radiographically Confirmed Pneumonia in Peruvian Children: From Symptoms to Imaging

Chest: The Journal of Circulation, Respiration and Related Systems

Miguel A. Chavez^1,2¹  Catherine H. Miele^1²  Laura E. Ellington^3³  Farhan Pervaiz^1⁴  Robert H. Gilman^2,4⁵  Matthew Grigsby^1⁶ 

[1] Biomedical Research Unit, A.B. PRISMA, Lima, Peru^2;Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, School of Medicine Johns Hopkins University, Baltimore, MD^6;Department of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, University of Washington, Seattle, WA^3;Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD^1;Instituto Nacional de Salud del Nino, Lima, Peru^5;Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD^4

关键词: auscultation;    lung ultrasound;    oxyhemoglobin saturation;    pneumonia;    prediction models;    AUC;    area under the curve;    CXR;    chest radiography;    LUS;    lung ultrasound;    Spo2;    oxyhemoglobin saturation;    WHP;    World Health Organization;   

DOI  :  10.1016/j.chest.2018.09.006

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Community-acquired pneumonia remains the leading cause of death in children worldwide, and current diagnostic guidelines in resource-poor settings are neither sensitive nor specific. We sought to determine the ability to correctly diagnose radiographically confirmed clinical pneumonia when diagnostics tools were added to clinical signs and symptoms in a cohort of children with acute respiratory illnesses in Peru. Methods Children 2), and addition of lung ultrasound. Results Of 832 children (mean age, 21.3 months; 59% boys), 453 (54.6%) had clinical pneumonia and 221 (26.6%) were radiographically confirmed. Children with radiographically confirmed clinical pneumonia had lower average Spo₂ than those without (95.9% vs 96.6%, respectively; P 2 did not improve classification (AUC = 0.73; 95% CI, 0.69-0.77) with a sensitivity of 40% (95% CI, 33%-47%) and specificity of 72% (95% CI, 68%-75%) for an Spo₂ ≤ 92%. Adding consolidation on lung ultrasound was associated with the largest improvement in classification (AUC = 0.85; 95% CI, 0.82-0.89) with a sensitivity of 55% (95% CI, 48%-63%) and specificity of 95% (95% CI, 93%-97%). Conclusions The addition of lung ultrasound and auscultation to clinical signs and symptoms improved the ability to correctly classify radiographically confirmed clinical pneumonia. Implementation of auscultation- and ultrasound-based diagnostic tools can be considered to improve diagnostic yield of pneumonia in resource-poor settings.

【 授权许可】

CC BY