Validation and development of a clinical prediction rule in clinically suspected community-acquired pneumonia.

OBJECTIVES: To develop a mathematical model to predict the probability of having community-acquired pneumonia and to evaluate an already developed prediction rule that has not been validated in a clinical scenario. METHODS: Children who presented with fever and had presumptive clinical diagnosis of pneumonia were evaluated in 4 institutions of different complexity during 1 year. The variables assessed were sex, age, respiratory rate, days with fever, maximum body temperature, presence of tachypnea, cough, chest pain, intercostal retraction, nasal flaring, abdominal pain, vomiting, grunting, rales, decreased breath sounds, wheezing, fatigue, loss of appetite, loss of sleep, and season of the year. The chest radiographs were photographed and then interpreted by 2 pediatric radiologists. RESULTS: A total of 257 children were evaluated: 179 (69%) had clinical and radiological diagnosis of community-acquired pneumonia, and 78 (30%) had no radiological confirmation. A total of 96 photographs were recorded, and in 64 of the cases, there was agreement in the diagnosis between the evaluating pediatrician and the radiologists (kappa index = 0.68).With the calculated probabilities, it was possible to build a receiving operating characteristic curve and, based on the estimated coefficients we calculated, a value associated to the probability of having pneumonia. CONCLUSIONS: We developed a model including 5 variables of high level of sensitivity for the diagnosis of pneumonia. To use it, it would be useful to apply the appropriate software. In addition, we validated a clinical prediction rule of 4 variables that proved to have 93.8% sensitivity to diagnose pneumonia in children with a fever and localized rales, or decreased breath sounds, or tachypnea, or any combination of these 4 variables.

Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina.

BACKGROUND: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children. METHODS: We conducted a retrospective case series involving children with acute infection of the lower respiratory tract or fever in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase-chain-reaction assay and who were admitted to one of six pediatric hospitals serving a catchment area of 1.2 million children. We compared rates of admission and death with those among age-matched children who had been infected with seasonal influenza strains in previous years. RESULTS: Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under 1 year of age (death rate, 7.6 per 100,000). CONCLUSIONS: Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.