Characteristics of Radiographically Diagnosed Pneumonia in Under-5 Children in Salvador, Brazil.

ABSTRACT

Objective: To assess the association of demographic and clinical aspects with radiographically diagnosed pneumonia. Design: By active surveillance, the admitted pneumonia cases by the pediatrician on duty were identified in a 2- year period. Demographic, clinical and radiographic data were registered into standardized forms. Setting: A public university pediatric hospital in Salvador, Northeast Brazil. Patients Children <5 years-old. Main outcome measures: Radiographically diagnosed pneumonia based on detection of pulmonary infiltrate/ consolidation. Results: 301 cases had the chest X-ray evaluated by a pediatric radiologist blinded to clinical information, among whom pulmonary infiltrate and consolidation were described in 161 (54%) and 119 (40%), respectively. Chest X-ray was read normal for 140 cases. Overall, the median age was 17 months (mean 20±14, range 12 days- 59 months). Pulmonary infiltrate was less frequently described among patients aged under 1 year (41.3% vs 59.9%, P=0.002, OR [95%CI] = 0.47 [0.29–0.76]) and hyperinflation was significantly more frequent in this age group (27.9% vs 4.1%, P<0.001, OR [95%CI] = 9.14 [4.0– 20.9]). By multiple logistic regression, fever on admission was independently associated with pulmonary infiltrate (OR [95%CI] = 1.68 [1.03-2.73]) or consolidation (1.79 [1.10-2.92]), wheezing was independently associated with absence of pulmonary infiltrate (0.53 [0.33-0.86]) or of consolidation (0.53 [0.33-0.87]). The positive likelihood ratio of fever on examination for pulmonary infiltrate and consolidation was 1.49 (95%CI 1.11–1.98) and 1.49 (95%CI 1.14-1.94), respectively. Conclusion: Presence of fever enhanced 2.5 times the chance of children hospitalized with lower respiratory tract disease to have radiographically diagnosed pneumonia.