O2178: Clinical Predictors of Radiographic Pneumonia in Children 1-60 Months Old Presenting with Acute Respiratory Symptoms

Background: The routine use of chest radiographs in the diagnosis of Pneumonia in children presenting with acute respiratory symptoms remains controversial and has not been recommended by major guidelines. In the clinical setting, individual signs and symptoms have not consistently proven to be a sufficiently effective tool in predicting the presence of pneumonia. However, a combination of signs and symptoms with the highest predictive values may be a reliable tool in making a diagnosis and reducing the reliance on routine chest radiographs in formulating a treatment plan when there is a suspicion of pneumonia.

Methods: We performed a single-center retrospective study of 1,631 children aged 1-60 months old presenting with acute respiratory symptoms to the Emergency room between September 2017 to September 2022. Documented symptoms, signs and radiographic findings were obtained from the electronic medical records for each of these encounters. We used multivariable logistic regression to develop a parsimonious model of clinical signs and symptoms associated with a positive chest radiograph.

Results: Of 1631 children who performed a chest radiograph, 619 (37.95%) had positive radiographic finding of pneumonia, 44.21% were older than 24 months, and 54.08% were males. One hundred (6.13%) met the clinical criteria of community acquired pneumonia (fever >38.50C, chest recessions and age defined tachypnea) of which 43% had negative radiographic confirmation. Patients with positive chest radiographs were more likely to have retractions, fever, tachypnea, low oxygen saturation, decreased breath sound, wheeze and less likely to have cough. After controlling for other variables in a parsimonious model (adjusted odd ratio; aOR), fever (aOR:1.80 96% CI-1.44, 2.24), retractions (aOR: 1.37 96% CI-1.03, 1.82), oxygen saturations < 94% (aOR:2.49 95% CI- 1.60, 3.88), decreased breath sounds (aOR:2.49 95% CI- 1.60, 3.88), rales (aOR:2.51 95% CI-1.80, 3.50) and wheeze (aOR:1.46 95% CI- 1.06, 2.01) were significantly associated with positive chest radiographs. This model had an area under curve of ~ 0.64 (95% CI 0.61-0.67) with a sensitivity of 26.98% and specificity of 88.90%

Conclusion: The Model created in this study showed that the presence fever, retractions, low oxygen saturation < 94%, rales, decreased breath sounds and wheeze were highly predictive of a radiographic finding of pneumonia in children aged 1-60 months presenting with acute respiratory symptoms.