Differences in Evolution of Children with Non-severe Acute Lower Respiratory Tract Infection With and Without Radiographically Diagnosed Pneumonia.
Loading...
Date
2012-05
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Objective: To identify differences in the evolution of children with
non-severe acute lower respiratory tract infection between those
with and without radiographically diagnosed pneumonia.
Design: Prospective cohort study.
Setting: A public university pediatric hospital in Salvador,
Northeast Brazil.
Patients: Children aged 2-59 months.
Methods: By active surveillance, the pneumonia cases were
prospectively identified in a 2-year period. Each case was
followed-up for changes in various clinical symptoms and signs.
Demographic, clinical and radiographic data were recorded in
standardized forms. Exclusion was due to antibiotic use in the
previous 48 hours, signs of severe disease, refusal to give
informed consent, underlying chronic illness, hospitalization in the
previous 7 days or amoxicillin allergy. Chest X-ray (CXR) was
later read by at least 2 independent pediatric radiologists.
Main Outcome Measures: Radiographic diagnosed pneumonia
based on agreed detection of pulmonary infiltrate or pleural
effusion in 2 assessments.
Results: A total of 382 patients receiving amoxicillin were studied,
of whom, 372 (97.4%) had concordant radiographic diagnosis
which was pneumonia (52%), normal CXR (41%) and others
(7%). By multivariate analysis, age (OR=1.03; 95% CI: 1.02-
1.05), disease ≥ 5days (OR = 1.04; 95% CI: 1.001-1.08), reduced
pulmonary expansion (OR = 3.3; 95% CI: 1.4-8.0), absence of
wheezing (OR = 0.5; 95% CI: 0.3-0.9), crackles on admission (OR
= 2.0; 95% CI: 1.2-3.5), inability to drink on day 1 (OR = 4.2; 95%
CI: 1.05-17.3), consolidation percussion sign (OR = 7.0; 95% CI:
1.5-32.3), tachypnea (OR = 2.0; 95% CI: 1.09-3.6) and fever (OR
= 3.6; 95% CI: 1.4-9.4) on day 2 were independently associated
with pneumonia. The highest positive predictive value was at the
2nd day of evolution for tachypnea (71.0%) and fever (81.1%).
Conclusion: Persistence of fever or tachypnea up to the second
day of amoxicillin treatment is predictive of radiographically
diagnosed pneumonia among children with non-severe lower
respiratory tract diseases.
Description
Keywords
Acute respiratory infection
Citation
Fontoura M-SH, Matutino A R, Silva C C, Santana M C, Nobre-Bastos M, Oliveira F, Barreto B B, Araújo-Neto C A, Andrade S C, Brim R V, Cardoso M-R A, Nascimento-Carvalho C M. Differences in Evolution of Children with Non-severe Acute Lower Respiratory Tract Infection With and Without Radiographically Diagnosed Pneumonia. Indian Pediatrics. 2012 May; 49(5): 363-369.