Pediatric Community-Acquired Pneumonia: Diagnosis and Management in the Emergency Department

Points and Pearls Excerpt

• Consider occult pneumonia in infants and children with high fever and leukocytosis—even in the absence of respiratory symptoms—as well as in pediatric patients with fever and abdominal pain.
• Suspect bronchiolitis in children aged < 2 years who present with upper respiratory symptoms that progress to lower respiratory symptoms and fever < 39°C (102.2°F).
• An aspirated foreign body should be considered in patients with recurrent lobar pneumonias.
• No one historical, physical examination, laboratory, or radiographic finding should be relied upon to diagnose pneumonia or to classify it as bacterial versus viral.

Most Important References

• Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25- e76. (Clinical guidelines)
• Toikka P, Irjala K, Juvén T, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000;19(7):598-602. (Case-control study; 126 patients)
• * Shah SN, Bachur RG, Simel DL, et al. Does this child have pneumonia?: The Rational Clinical Examination Systematic Review. JAMA. 2017;318(5):462-471. (Systematic review; 23 prospective cohort studies, 13,833 children) 
• Murphy CG, van de Pol AC, Harper MB, et al. Clinical predictors of occult pneumonia in the febrile child. Acad Emerg Med. 2007;14(3):243-249. (Cross-sectional study; 2128 subjects) 
• * Reali F, Sferrazza Papa GF, Carlucci P, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children? Respiration. 2014;88(2):112- 115. (Prospective study; 107 patients)