Abstract
Background
Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia.
Objective
To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia.
Study design
Multicenter prospective cohort study.
Participants
Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI).
Outcome measures
Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2.
Results
Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria. Based on any abnormality on chest x ray (CXR), 46% had pneumonia. The sensitivity and specificity of the existing WHO criteria for diagnosis of pneumonia was 56.5% and 66.2%, respectively, when compared against abnormalities in CXR. Cough and fever, each had sensitivity of >80%. Audible wheeze and breathing difficulty, each had a specificity of >80%. Sensitivity and specificity of tachypnoea were 58.7% and 63.3%, respectively. None of the clinical features alone had a sensitivity and specificity of >80%. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia.
Conclusions
Current WHO criteria based on rapid respiratory rate and/or chest indrawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increases the probability of pneumonia diagnosis, and is important in the management of a child with pneumonia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McAllister DA, Liu L, Shi T, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: A systematic analysis. Lancet Glob Health. 2019;7:e47–57.
Fadel SA, Boschi-Pinto C, Yu S, et al. Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: An analysis of nationally representative mortality studies. Lancet. 2019;393:1119–27.
Shah SN, Bachur RG, Simel DL, Neuman MI. Does This child have pneumonia? The rational clinical examination systematic review. JAMA. 2017;318:462–71.
World Health Organization (WHO). The management of acute respiratory infections in children In: Practical guidelines for outpatient care. Geneva: WHO, 1995.
Sazawal S, Black RE, Pneumonia Case Management Trials Group. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Lancet Infect Dis. 2003;3:547–56.
Hazir T, Qazi SA, Bin Nisar Y, et al. Comparison of standard versus double dose of amoxicillin in the treatment of non-severe pneumonia in children aged 2–59 months: a multicentre, double blind, randomized controlled trial in Pakistan. Arch Dis Child. 2007;92:291–7.
Harari M, Shann F, Spooner V, Meisner S, Carney M, de Campo J. Clinical signs of pneumonia in children. Lancet. 1991;338:928–30.
Rambaud-Althaus C, Althaus F, Genton B, D’Acremont V. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. Lancet Infect Dis. 2015;15:439–50.
Mulholland EK, Simoes EA, Costales MO, McGrath EJ, Manalac EM, Gove S. Standardized diagnosis of pneu-monia in developing countries. Pediatr Infect Dis J. 1992; 11:77–81.
Singhi S, Dhawan A, Kataria S, Walia BN. Validity of clinical signs for the identification of pneumonia in children. Ann Trop Paediatr. 1994;14:53–8.
Redd SC, Vreuls R, Metsing M, Mohobane PH, Patrick E, Moteetee M. Clinical signs of pneumonia in children attending a hospital outpatient department in Lesotho. Bull World Health Organ. 1994;72:113–8.
Falade AG, Tschäppeler H, Greenwood BM, Mulholland EK. Use of simple clinical signs to predict pneumonia in young Gambian children: the influence of malnutrition. Bull World Health Organ. 1995;73:299–304.
Awasthi S, Rastogi T, Mishra N, et al. Chest radiograph findings in children aged 2–59 months hospitalised with community-acquired pneumonia, prior to the introduction of pneumococcal conjugate vaccine in India: a prospective multisite observational study. BMJ Open. 2020;10:e034066.
World Health Organization (WHO). Revised WHO classification and treatment of childhood pneumonia at health facilities, 2014. Accessed on 29 August, 2019. Available at: https://www.who.int/maternal_child_adolescent/documents/child-pneumonia-treatment/en
Dowell SF, Schwartz B, Phillips WR. Appropriate use of antibiotics for URIs in children: Part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. Am Fam Physician. 1998;58:1113–8,1123.
Cherian T, Mulholland EK, Carlin JB, et al. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ. 2005;83:353–9.
Mathew JL, Patwari AK, Gupta P, et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2011;48:191–218.
Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86:408–16.
Palafox M, Guiscafre H, Reyes H, Munoz O, Martinez H. Diagnostic value of tachypnoea in pneumonia defined radiologically. Arch Dis Child. 2000;82:41–5.
Leventhal J. Clinical predictors of pneumonia as a guide to ordering chest roentgenograms. Clin Pediatr. 1982;21:730–4.
Campbell H, Byass P, Lamont AC, et al. Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children. Lancet. 1989;1:297–9.
British Thoracic Society. British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood. Thorax. 2002;57:i1–24.
Mahabee-Gittens EM, Grupp-Phelan J, Brody AS, et al. Identifying children with pneumonia in the emergency department. Clin Pediatr (Phila). 2005;44:427–35.
Acknowledgements
AIIMS Bhubaneswar: Ms Jyotshnarani Sahoo and Ms Manaswini Biswal; AIIMS Jodhpur: Mr Vikas Patwa; KIMS Hubli: Dr Prakash Wari (HOD Pediatrics), Vedasree and Gayatri; SKIMS Srinagar: Umaisa Zehra and Saba.
Funding
Funding: This work was supported by Bill and Melinda Gates Foundation through The INCLEN Trust International (Grant number: OPP1084307). The funding source had no contribution in study design, implementation, collection and interpretation of data and report writing.
Author information
Authors and Affiliations
Contributions
RRD: involved in protocol development, supervision of study, data collection and analysis, and manuscript writing. AKS: involved in data collection, management of patients, and manuscript writing. AM, RL: involved in protocol development, data analysis, and manuscript writing. JPG, JIB, VHR, BV: involved in protocol development, and manuscript writing. All the authors have approved the manuscript version to be published.
Corresponding author
Ethics declarations
The study was approved by Institutional ethics committee of all the six study sites.
Additional information
Competing interest
None stated.
List of ATU Group members provided in annexure I.
Rights and permissions
About this article
Cite this article
Das, R.R., Satapathy, A.K., Mukherjee, A. et al. Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months. Indian Pediatr 58, 1024–1029 (2021). https://doi.org/10.1007/s13312-021-2367-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-021-2367-3