Abstract
BACKGROUND: Chest radiographs (CXRs) are frequently used in the diagnosis of community-acquired pneumonia (CAP). We sought to construct a predictive model for radiographic CAP based on clinical features to decrease CXR use. METHODS: We performed a single-center prospective study of patients 3 months to 18 years of age with signs of lower respiratory infection who received a CXR for suspicion of CAP. We used penalized multivariable logistic regression to develop a full model and bootstrapped backward selection models to develop a parsimonious reduced model. We evaluated model performance at different thresholds of predicted risk. RESULTS: Radiographic CAP was identified in 253 (22.2%) of 1142 patients. In multivariable analysis, increasing age, prolonged fever duration, tachypnea, and focal decreased breath sounds were positively associated with CAP. Rhinorrhea and wheezing were negatively associated with CAP. The bootstrapped reduced model retained 3 variables: age, fever duration, and decreased breath sounds. The area under the receiver operating characteristic for the reduced model was 0.80 (95% confidence interval: 0.77–0.84). Of 229 children with a predicted risk of <4%, 13 (5.7%) had radiographic CAP (sensitivity of 94.9% at a 4% risk threshold). Conversely, of 229 children with a predicted risk of >39%, 140 (61.1%) had CAP (specificity of 90% at a 39% risk threshold). CONCLUSIONS: A predictive model including age, fever duration, and decreased breath sounds has excellent discrimination for radiographic CAP. After external validation, this model may facilitate decisions around CXR or antibiotic use in CAP.
| Original language | English (US) |
|---|---|
| Article number | e2021051405 |
| Pages (from-to) | 47-58 |
| Number of pages | 12 |
| Journal | Pediatrics |
| Volume | 149 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2022 |
Funding
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Supported by the National Institutes of Health National Institute of Allergy and Infectious Diseases (K23AI121325 and R03AI147112 to Dr Florin and K01AI125413 to Dr Ambroggio), the Gerber Foundation (to Dr Florin), National Institutes of Health National Center for Research Resources and Cincinnati Center for Clinical and Translational Science and Training (5KL2TR000078 to Dr Florin). The funders did not have any role in study design, data collection, statistical analysis, or article preparation. Funded by the National Institutes of Health (NIH). POTENTIAL CONFLICT OF INTEREST: The authors have no conflicts of interest relevant to this article to disclose. FUNDING: Supported by the National Institutes of Health National Institute of Allergy and Infectious Diseases (K23AI121325 and R03AI147112 to Dr Florin and K01AI125413 to Dr Ambroggio), the Gerber Foundation (to Dr Florin), National Institutes of Health National Center for Research Resources and Cincinnati Center for Clinical and Translational Science and Training (5KL2TR000078 to Dr Florin). The funders did not have any role in study design, data collection, statistical analysis, or article preparation. Funded by the National Institutes of Health (NIH).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health