Prevalence and predictors of radiographic pneumonia in children with wheeze: A systematic review and meta-analysis.

IF 3.4 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2024-08-27 DOI:10.1111/acem.15006

Sonal N Shah, Michael C Monuteaux, Mark I Neuman

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引用次数: 0

Abstract

Background: Diagnostic uncertainty exists surrounding the identification of radiographic pneumonia in children with wheeze. It is important to determine the prevalence and clinical predictors of pneumonia in this population to limit chest radiography (CXR) and promote judicious antibiotic use.

Objectives: The objectives were to (1) estimate the prevalence of radiographic pneumonia in children with wheeze and (2) systematically review the diagnostic accuracy of clinical findings for the identification of radiographic pneumonia.

Methods: Data sources were MEDLINE, PubMed Central, Cochrane Library, CINAHL, and Web of Science (January 1995 to September 2023). For study selection, two reviewers identified high-quality studies reporting on clinical characteristics associated with radiographic pneumonia in wheezing children (age 0-21 years). Using Covidence software, data regarding study characteristics, methodologic quality, and results were extracted. Data were pooled using random-effects meta-analysis.

Results: A total of 8333 unique titles and abstracts were reviewed. Twelve studies, representing 7398 patients, were included. Fifteen percent of children with wheeze undergoing CXR had pneumonia. Findings associated with radiographic pneumonia included temperature ≥ 38.4°C (positive likelihood ratio [LR+] 2.1, 95% CI 1.2-3.6, specificity 85%), oxygen saturation < 92% (LR+ 3.6, 95% CI 1.4-8.9, specificity 89%), and grunting (LR+ 2.7, 95% CI 1.6-4.4, pooled specificity 91%). Factors associated with the absence of radiographic pneumonia included lack of fever (negative likelihood ratio [LR-] 0.67, 95% CI 0.52-0.85) and oxygen saturation ≥ 95% (LR- 0.64, 95% CI 0.42-0.98). Tachypnea and auscultatory findings were not associated with radiographic pneumonia.

Discussion: Heterogeneity across studies limits generalizability. Additionally, all included studies overestimate the rate of radiographic pneumonia given the fact that all subjects had a CXR performed due to clinical suspicion of pneumonia.

Conclusions: Radiographic pneumonia occurs in 15% of wheezing children undergoing CXR for pneumonia. Auscultatory findings and tachypnea do not differentiate children with and without pneumonia, and the rate of radiographic pneumonia is very low in the absence of fever and hypoxemia.

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喘息患儿放射性肺炎的发病率和预测因素：系统回顾和荟萃分析。

背景：喘息患儿的影像学肺炎诊断存在不确定性。确定这一人群中肺炎的患病率和临床预测因素对于限制胸部放射摄影（CXR）和促进抗生素的合理使用非常重要：目的：(1) 估算喘息患儿中放射性肺炎的患病率；(2) 系统回顾临床发现对鉴别放射性肺炎的诊断准确性：数据来源于 MEDLINE、PubMed Central、Cochrane Library、CINAHL 和 Web of Science（1995 年 1 月至 2023 年 9 月）。在选择研究时，两名审稿人确定了报告喘息型儿童（0-21 岁）放射性肺炎相关临床特征的高质量研究。使用 Covidence 软件提取了有关研究特征、方法学质量和结果的数据。采用随机效应荟萃分析法对数据进行汇总：结果：共审查了 8333 篇标题和摘要。共纳入 12 项研究，代表 7398 名患者。在接受 CXR 检查的喘息患儿中，15% 患有肺炎。与放射性肺炎相关的检查结果包括体温≥38.4°C（阳性似然比 [LR+] 2.1，95% CI 1.2-3.6，特异性 85%）、血氧饱和度：不同研究之间的异质性限制了研究的普遍性。此外，所有纳入的研究都高估了放射性肺炎的发生率，因为所有受试者都因临床怀疑肺炎而进行了 CXR 检查：结论：在因肺炎接受 CXR 检查的喘息患儿中，15% 的患儿会出现放射性肺炎。结论：在因肺炎接受 CXR 检查的喘息患儿中，15% 的患儿会出现放射性肺炎。听诊结果和呼吸急促并不能区分患儿是否患有肺炎，在没有发烧和低氧血症的情况下，放射性肺炎的发生率非常低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.