ABSTRACT

Background

Clinicians in resource-limited settings commonly use the World Health Organization criteria to diagnose pneumonia in children.

Aim

The aim of this study was to prospectively evaluate the diagnostic accuracy of the WHO criteria compared with chest radiograph for the diagnosis of pneumonia in children under 5 years of age presenting to an emergency department (ED) in Nepal.

Methods

A prospective cross-sectional study of children presenting to an ED with respiratory complaints in Nepal was conducted. It included all children under 5 years of age with cough or difficulty breathing who received a chest radiograph. Paediatric pneumonia was diagnosed according to WHO criteria when a child presented with a cough or difficulty breathing and met the age-related WHO-defined respiratory rate for tachypnoea. The criterion standard was radiographic pneumonia. The primary outcome was the sensitivity and specificity of the WHO criteria for diagnosis of pneumonia.

Results

Of 324 patients enrolled, 72 had radiographic pneumonia. The median (IQR) age was 17 (23) months. Overall, WHO criteria had a sensitivity of 71% (95% CI 59–81) and specificity of 57% (95% CI 50–63). Respiratory rate had poor diagnostic accuracy for pneumonia with an area under the curve of 0.65.

Conclusion

The WHO criteria had poor sensitivity and specificity for the diagnosis of pneumonia in children presenting to the ED in a resource-limited setting.

中文翻译：

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世界卫生组织关于资源有限环境中急诊科儿童肺炎诊断指南的前瞻性评估。

摘要

背景

资源有限环境中的临床医生通常使用世界卫生组织的标准来诊断儿童肺炎。

目的

本研究的目的是前瞻性地评估 WHO 标准与胸片相比，在诊断尼泊尔急诊科 (ED) 的 5 岁以下儿童肺炎时的诊断准确性。

方法

对尼泊尔因呼吸系统疾病就诊的儿童进行了前瞻性横断面研究。它包括所有接受胸片检查的 5 岁以下咳嗽或呼吸困难的儿童。当儿童出现咳嗽或呼吸困难并符合 WHO 定义的与年龄相关的呼吸急促呼吸频率时，根据 WHO 标准诊断小儿肺炎。标准是放射照相肺炎。主要结果是WHO肺炎诊断标准的敏感性和特异性。

结果

在入组的 324 名患者中，72 名患有放射影像学肺炎。中位 (IQR) 年龄为 17 (23) 个月。总体而言，WHO 标准的敏感性为 71%（95% CI 59-81），特异性为 57%（95% CI 50-63）。呼吸频率对肺炎的诊断准确性较差，曲线下面积为 0.65。

结论

在资源有限的情况下，WHO 标准对于诊断急诊儿童肺炎的敏感性和特异性较差。