New model predicting risk of pneumonia in children could help cut down x-rays

In order to streamline the process of diagnosing pneumonia in children and cut down on the need for x-rays, a team of U.S. researchers has come up with a model to predict which patients are at high or low risk of community acquired pneumonia.

For young children, pneumonia — an infection that can cause the lungs to fill with fluid — can be life-threatening in severe cases, making it important to identify when a child has contracted it in the community.

Using x-rays to confirm a diagnosis is the standard procedure, but there have been recommendations to limit the use of x-rays, which researchers were hoping to address.

“Our predictive model for community acquired pneumonia is a critical step toward safely reducing radiation exposure in children,” Dr. Sriram Ramgopal, emergency medicine physician at Lurie Children’s Hospital of Chicago, assistant professor of Pediatrics at Northwestern University’s medical school and lead author of the research, said in a press release. “For patients who are determined to be at low risk for pneumonia, we can also avoid unnecessary antibiotic use.”

To create a model that could predict which children might be more at risk of pneumonia, researches looked at the records of 1,142 patients aged three months to 18 years who had been tested for community acquired pneumonia in the past.

By looking at these records, researchers narrowed in on a few common characteristics that could help indicate the high or low risk of pneumonia. These include increasing age, the duration of fevers and breathing that sounds decreased during a stethoscope exam.

Of the 1,142 patients, 253 were confirmed by x-ray to have community acquired pneumonia. These patients tended to be of an older age, had a prolonged fever and “focal decreased breath sounds”.

Having a runny nose and wheezing were negatively associated with pneumonia in the study, despite being symptoms that can indicate the illness.

“Since our model does not rely on lab results, it may allow for broader implementation in the primary care setting,” Dr. Todd Florin, director of research in Emergency Medicine at Lurie Children’s Hospital, associate professor of Pediatrics at Northwestern University and senior author of the research, said in the release.

“If validated by other centres, this model could be implemented using an online calculator of risk or through clinical decision support tools that can be embedded in the electronic medical record.”

All of the patients in the study were sourced from the same centre, Ann & Robert H. Lurie Children’s Hospital of Chicago, and had a lower respiratory infection that prompted a chest x-ray to test for pneumonia.

The model does not aim to replace the x-ray as a diagnostic tool for community acquired pneumonia, but could help cut down on exposing children to x-rays if they are at a very low risk of having pneumonia. CTV News