Characteristics of radiographically diagnosed pneumonia in under-5 children in Salvador, Brazil

To assess the association of demographic and clinical aspects with radiographically diagnosed pneumonia. By active surveillance, the admitted pneumonia cases by the pediatrician on duty were identified in a 2-year period. Demographic, clinical and radiographic data were registered into standardized forms. A public university pediatric hospital in Salvador, Northeast Brazil. Children < 5 years-old. Radiographically diagnosed pneumonia based on detection of pulmonary infiltrate/consolidation. 301 cases had the chest X-ray evaluated by a pediatric radiologist blinded to clinical information, among whom pulmonary infiltrate and consolidation were described in 161 (54%) and 119 (40%), respectively. Chest X-ray was read normal for 140 cases. Overall, the median age was 17 months (mean 20 +/- 14, range 12 days-59 months). Pulmonary infiltrate was less frequently described among patients aged under 1 year (41.3% vs 59.9%, P=0.002, OR [95%CI] = 0.47 [0.29-0.76]) and hyperinflation was significantly more frequent in this age group (27.9% vs 4.1%, P < 0.001, OR [95%CI] = 9.14 [4.0-20.9]). By multiple logistic regression, fever on admission was independently associated with pulmonary infiltrate (OR [95%CI] = 1.68 [1.03-2.73]) or consolidation (1.79 [1.10-2.92]), wheezing was independently associated with absence of pulmonary infiltrate (0.53 [0.33-0.86]) or of consolidation (0.53 [0.33-0.87]). The positive likelihood ratio of fever on examination for pulmonary infiltrate and consolidation was 1.49 (95%CI: 1.11-1.98) and 1.49 (95%CI: 1.14-1.94), respectively. Presence of fever enhanced 2.5 times the chance of children hospitalized with lower respiratory tract disease to have radiographically diagnosed pneumonia.