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Four clinical factors can help diagnose pneumonia in children seen in hospital emergency departments

Four clinical factors—respiratory rate, oxygen saturation, age, and nasal flaring—can help diagnose pneumonia in children who arrive at the emergency department (ED) with symptoms of lower respiratory tract infection, according to a study supported by the Agency for Healthcare Research and Quality (HS11038). Children with a respiratory rate of 50 breaths per minute or more are more than 3 times as likely to have x-ray evidence of pneumonia; those with oxygen saturation of 96 percent or less (hypoxia or oxygen deficiency) are nearly 5 times more likely; and those older than 12 months are 40 percent more likely. Finally, infants younger than 12 months who have nasal flaring are more than twice as likely to have x-ray evidence of pneumonia.

Melinda Mahabee-Gittens, M.D., M.S., and colleagues at Cincinnati Children's Hospital Medical Center evaluated children aged 2 to 59 months who arrived at the hospital's ED in 2000-2002 with a cough and one or more of the following symptoms: labored, rapid, or noisy breathing; chest or abdominal pain; or fever. Out of a total of 510 children in the study, 8.6 percent had x-ray evidence of pneumonia. Children who had pneumonia differed from children who did not on four characteristics: older age (20.9 vs. 14.8 months); faster respiratory rate (49.8 vs. 42.7 breaths per minute); lower oxygen saturation (95.5 vs. 97.8); and nasal flaring (22.7 vs. 7.7 percent).

See "Identifying children with pneumonia in the emergency department," by Dr. Mahabee-Gittens, Jacqueline Grupp-Phelan, M.D., M.P.H., Alan S. Brody, M.D., and others, in the June 2005 Clinical Pediatrics 44, pp. 427-435.

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