Another glass half-full vs half-empty, depending on how you read it. Their editor capsule summary says “Children without hypoxia, fever, and ausculatory findings are low risk.” The numbers say – in the absence of hypoxia, fever, or focal ausculatory findings, radiographic pneumonia was seen in 7.6% (CI 5.3-10.0). Interesting numbers that, to me, say that pediatric pneumonia is still a black box of uncertainty.
However, what the authors call “definite” pneumonia was only 2.9% in the absence of those findings, and the editor’s capsule conclusion is that low-risk patients are best served by follow-up rather than radiology. And, this is where the half-full/half-empty comes in – because a lot of EPs don’t want to the guy that sends home pneumonia even in a “low risk” situation, given than 30% of their pneumonia diagnoses required admission. I’d rather take the half-full approach – recognizing that the majority of radiographic pneumonias are viral anyway, and, if the patient has adequate follow-up and tunes up nicely, do my best to avoid unnecessary testing in a low pretest probability setting that will end up with more false positives and unnecessary antibiotics.
“Prediction of Pneumonia in a Pediatric Emergency Department”