UMEM Educational Pearls

Title: Pneumonia Risk Score for pediatric pneumonia.

Keywords: peds, chest xray, pneumonia. (PubMed Search)

Posted: 3/18/2022 by Jenny Guyther, MD
Click here to contact Jenny Guyther, MD

In emergency departments in the US, the diagnosis of pneumonia is often made on chest xray. In the outpatient setting, national guidelines focus on the clinical diagnosis of pneumonia and recommend against radiographs. This study aimed to develop and validate a clinical tool that could be used to determine the risk of radiographic pneumonia.

The criteria in the Pneumonia Risk Score (PRS) evaluate for the presence of fever, rales, and wheeze and take into account age and triage oxygen saturation. When developing this protocol, the investigators compared the patients who had pneumonia on chest xray with both clinical judgment and the PRS. The PRS outperformed clinical judgment in predicting which patients would have pneumonia on chest xray.

Children who have a score of 2 or less were unlikely to have pneumonia on chest xray and would qualify for observation without an xray or empiric antibiotics use. Children who had a score of 5 or greater were likely to have radiographic pneumonia and could be empirically treated with antibiotics. If the PRS score was 6, the specificity was 99.9%

This link https://links.lww.com/INF/E552. takes you to the excel spreadsheet where you can enter the patients clinical data and gives you a present probability of radiographic pneumonia. (In case the link does not work, it is also found in the supplemental digital content.)

Bottom line: PRS outperforms clinical judgment when determining if pneumonia will be present on the pediatric chest xray.

References

Lipsett, Susan C. MD*,†,‡; Hirsch, Alexander W. MD*,†; Monuteaux, Michael C. ScD*,†; Bachur, Richard G. MD*,†,‡; Neuman, Mark I. MD, MPH*,†,‡ Development of the Novel Pneumonia Risk Score to Predict Radiographic Pneumonia in Children, The Pediatric Infectious Disease Journal: January 2022 - Volume 41 - Issue 1 - p 24-30.