Tachypnea useful in diagnosis of pneumonia in children


CLINICA CAYANGA
Clinical Updates	Tachypnea useful in diagnosis of pneumonia in children
Alzheimer's Disease Arthritis Asthma Benign Prostatic Hypertrophy Chronic Lymphocytic Leukemia Coronary Artery Disease Depression Diabetes Mellitus Dyspepsia Erectile Dysfunction Fatty Liver Gallstone Hepatitis Hypertension Lung Cancer Mesothelioma Metabolic Syndrome Obesity Pneumonia Pregnancy Prostate Cancer Sinusitis Stroke Tinnitus	Clinical Question: Can tachypnea be used to predict pneumonia in febrile children younger than two years of age? Bottom Line: This is a well done study with appropriate blinding of both the application of the clinical test and diagnosis of the target disease. Tachypnea is an important predictive sign of pneumonia in febrile children younger than 2 years. Conversely, the absence of tachypnea obviates the need for chest radiography in most settings. The technique of auscultating the chest for a full 60 seconds to determine respiratory rates can be replicated in clinical practice. It is uncertain whether respiratory rates obtained by other means would be as useful as those obtained in this study. In the evaluation of febrile children younger than 2 years, respiratory rates below the standard of tachypnea as defined in this study correlated well with the absence of pneumonia. Applying this information to clinical practice may lead to decreased utilization of chest radiography, unnecessary exposure to radiation, and reduced costs. Reference: Taylor JA, Del Beccaro M, Done S, Winters W. Establishing Clinically Relevant Standards for Tachypnea in Febrile Children Younger Than 2 Years. Arch Ped Adol Med 1995; 149: 283-7. (January, 1996) Study Design: Cross-sectional Synopsis: Tachypnea is an important predictor of pneumonia in pediatric patients but there is no widely accepted definition of what it is, especially in febrile children. Values for normal respiratory rates were measured on well, sleeping children. An accurate definition for tachypnea among febrile children may aid clinicians in determining those likely to have pneumonia. The authors did a prospective case series to children younger than 2 years presenting to the emergency department of a children's hospital with a temperature of 38 degrees C or higher. Using a standardized method, respiratory rates were obtained on eligible children for 1 year. Study patients were classified as having pneumonia or no pneumonia based on clinical evaluation and chest radiograph findings. Receiver operating characteristic curves were constructed to select the values for respiratory rate that maximized sensitivity and specificity of tachypnea as a sign of pneumonia. Data were analyzed for 572 children; pneumonia was present in 42 (7%). The diagnostic utility of tachypnea was maximal when cutoff values for respiratory rates of 59/min in infants younger than 6 months, 52/min in those aged 6 through 11 months, and 42/min in those aged 1 to 2 years were selected. Based on these definitions, tachypnea as a sign of pneumonia had a sensitivity of 73.8%, specificity of 76.8%, positive predictive value of 20.1%, and negative predictive value of 97.4%.
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