Usefulness of physical examination at a primary health centre to diagnose infant pneumonia caught in the community

• Published in: Atención primaria Vol. 32; no. 6; pp. 349 - 354
• Main Authors: Buñuel Alvarez, J C, Vila Pablos, C, Heredia Quiciós, J, Lloveras Clos, M, Basurto Oña, X, Gómez Martinench, E, Pont Vallès, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 15.10.2003
• Subjects: Adolescent; Child; Child, Preschool; Community-Acquired Infections - diagnosis; Community-Acquired Infections - diagnostic imaging; Community-Acquired Infections - epidemiology; Health Facilities; Humans; Infant; Physical Examination; Pneumonia - diagnosis; Pneumonia - diagnostic imaging; Pneumonia - epidemiology; Prevalence; Primary Health Care; Radiography
• ISSN: 0212-6567

To determine the diagnostic usefulness of three clinical signs (temperature, cough, crepitant stertor) for diagnosing pneumonia in children. To evaluate the agreement of two radiologists in evaluating thoracic x-rays (TXR). Study of diagnostic tests. Primary care. 350 clinical histories of children who had an urgent TXR to diagnosis pneumonia between 1st January 1996 and 30th June 1999. a) Prevalence of pneumonia in the entire sample and two age-based sub-groups: aged 5 years and under, and over 5; b) positive probability quotients (PQ+) and negative ones (PQ-) and 95% confidence intervals (95% CI). The TXR was seen as the reference standard, and c) kappa index (kappa) for inter-radiologist concordance. Prevalence: the entire sample, 22.9% (95% CI, 18.5-27.3); children aged 5 or less, 20.4% (95% CI, 15.6-25.2); aged over 5, 31.3% (95% CI, 21.1-41.4). The signs studied were only of any use in confirming the diagnosis in children over 5: PQ+ was 3.52 (1.28-9.69). Radiologists coincided in their diagnosis in 93.1% of the TXR (kappa=0.8; 95% CI, 0.77-0.83). This study did not prove that there was a sub-grouping of clinical signs which confirmed unmistakably the diagnosis of pneumonia in children.