Clinical Predictors of Pneumonia among Children upto 12 Years of Age with Wheezing

INTRODUCTION: Asthma, bronchiolitis and pneumonia are commonly seen causes of respiratory distress in children. Among children with wheeze co-existing pneumonia is the leading cause of morbidity and mortality. Hence it is vital to diagnose and treat pneumonia early. The estimated incidence of pneumonia in children less than 5 years of age, in developing countries, in the year 2000 was 0.28 episodes per child-year whereas in developed countries, it is 0.05 episodes per child-year. Community acquired pneumonia has its greatest impact in the developing countries. Pneumonia is the leading cause of death among children under five years of age (24% of all deaths under 5 years of age) in India. About 1.2 million annual deaths are reported worldwide among children less than 5 years of age with pneumonia which is more than malaria, tuberculosis and AIDS combined [WHO]. Lower respiratory tract infections account for 11.3% of all deaths in the low income countries. Pneumonia can be defined as inflammation of lung tissue often initiated by an infectious agent resulting in lung damage. AIM OF THE STUDY: Aim of this study is to investigate the value of symptoms and signs in predicting co-existing pneumonia, in children upto 12 years of age with wheezing. This will help in developing a clinical decision rule, for the use of chest x-ray, and also guide in further management of this patient population. DISCUSSION: This is a descriptive study conducted in children 0-12 years of age with wheeze on examination. Children in the age group of 0-1 year of age have an increased risk of developing pneumonia (p=0.038) in this study, which differs from the study conducted by Bony Mathews where there was no age predilection to develop pneumonia. Since our institute is a tertiary referral centre further multi center studies are needed to confirm this. There was a male preponderance (64.6%) in this study. However there was no sex predilection to developing pneumonia in our study which is consistent with other studies. In this study, radiographic pneumonia was present in 47 (12.2%) out of the 384 patients in the study population. Similar study conducted by Bony Mathews showed a prevalence of 4.9% in children with wheeze. Slightly higher prevalence in our population may be because this study was conducted in a tertiary referral centre one of the largest in South India. The strongest predictors of pneumonia after step by step logistic regression analyses in our study were temperature ≥39 degree Celsius, oxygen saturation ≤ 96% and focal crepitations. Among the three, temperature ≥ 39 degree Celsius occupies maximum area in the ROC cureve and hence has the greatest accuracy of predicting pneumonia in our study, which is similar to many other studies conducted so far. In a study conducted by Bony Mathews, history of fever was predictive of pneumonia in all age groups. But in our study, history of fever was predictive of pneumonia in children less than 5 years only. This may be due to less number of children present in the age group of 5-12 years in our study. However duration of fever > 3 days was associated with pneumonia in all the three age groups in our study. CONCLUSION: 1. Children with wheeze can be stratified into two groups, high or low risk based on our history and clinical examination. 2. Presence of fever is a highly sensitive predictor of pneumonia. Patients with temperature ≥ 39 degree Celsius, focal crepitations, oxygen saturation ≤ 96% are more likely to have radiographic pneumonia