Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

Sandeep Shrestha,Saneep Shrestha,Santosh Pathak,Om P Kurmi,Arun Sharma,Laxman Shrestha,Nagendra Chaudhary,Frederick Quinn

doi:10.1371/journal.pone.0235598

Abstract

Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal. This cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3-60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia. Out of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors. Tachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

Highlights

Pneumonia is one of the most common causes of childhood infections attributed to about 2 million children deaths worldwide [1]
Out of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study
During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia

Summary

Introduction

Pneumonia is one of the most common causes (followed by prematurity related deaths) of childhood infections attributed to about 2 million children deaths worldwide [1]. The World Health Organization (WHO) uses tachypnea (age 2–11 months, 50/min; age 1–5 years, 40/min) and/or lower chest indrawing as a sole criterion to diagnose pneumonia in children with a cough or breathing difficulty [3]. In low- and middle-income countries (LMICs), including Nepal, chest x-ray usually remains the diagnostic test of choice and often, health workers, including treating physicians, use WHO guidelines to diagnose and treat pneumonia [4]. Earlier studies reported the clinical predictors of radiological pneumonia when the cases associated with radiological pneumonia were usually caused by bacterial agents mostly Streptococcus pneumoniae and Hemophilus influenzae [7,8,9]. Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal

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