Diagnosis of childhood pneumonia clinical assessment without radiological confirmation may lead to overtreatment

ARTICLE SUMMARY: DIAGNOSIS OF CHILDHOOD PNEUMONIA CLINICAL ASSESSMENT WITHOUT RADIOLOGICAL CONFIRMATION MAY LEAD TO OVERTREATMENT
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Article Summary: Diagnosis of Childhood Pneumonia Clinical Assessment without Radiological Confirmation May Lead to Overtreatment
There has been no consensus over the best pneumonia diagnosis considering its prevalence in children, with clinical prediction rules of many studies failing in both sensitivity and specificity. Many developing countries for lack of robust medical infrastructure and scarcity of medical centers have relied on the World Health Organization treatment guidelines which emphasize on physical examination, more so on the respiratory rate. However, this purely approach has occasioned the reduction of pneumonia related morbidity and death among children in this context. The guidelines in developed countries indicate that if a child presents with systems such as fever and cough and the physical examination of tachypnea, hypoxia, rales, decreased air entry diagnosis should be made entirely on clinical grounds.
There have been concerns over reliance on the clinical diagnosis in that though it may save those children without pneumonia from x-ray exposure, it can lead to overuse of antibiotics in those with no pneumonia, which could increase the resistance of pathogens to antibiotics. The WHO guidelines as used in developed countries have shown a failure rate of 34% which was confirmed by radiology. Despite data showing that more than half of children with signs suggestive of pneumonia yet registering negative x-rays, overtreatment in the developing world has not been addresses. The link between clinical diagnosis of pneumonia and radiological finding to measure the level of over-diagnosis and thus likely overtreatment with pneumonia antibiotics in children diagnosed on clinical grounds was established in a study conducted in Israel. The sample was 687 children, with 41.1% male and 58.3% female their mean age being 2.5 yrs. The study which was conducted between mid 1007 and early 2008 shows showed that treating children for pneumonia based only on clinical signs can lead to a 55% to 75% overtreatment rate, depending on the signs and symptoms that predicated the clinical decision.
Hearing wheezing extensively affirms the nonexistence of radiologically confirmed pneumonia according to other studies; however this study shows that 25.3% of wheezing children had pneumonia. Further, the study showed a clear association between fever and radiological pneumonia. The sensitivity of fever was 99%...