Acute Respiratory Infections Case Definitions

Acute Respiratory Infections Case Definitions Dr Claudia Turner Research Paediatrician SMRU Case Definitions • Pneumonia – Children & Infants – Adults • Avian Influenza Children and Infants Pneumonia Diagnosis of Pneumonia in Children  The best individual way of ruling out pneumonia is the absence of tachypnoea • Symptoms that support a diagnosis of pneumonia • • • • Difficulty in breathing Fever Difficulty in feeding Restlessness Margolis, P. and A. Gadomski. Jama, 1998. 279(4): 308-13 Adegbola, R.A. and S.K. Obaro. Ann Trop Med Parasitol, 2000. 94(3): 197-207 Diagnosis of Pneumonia in Children • The presence of either a RR >50 breaths/min or chest indrawing, or both, was a good indication that a child had pneumonia • The presence of auscultatory signs increases the specificity but lowers the sensitivity Harari, M., et al. Lancet 1991 338(8772): 928-30 Zar,H.J., Current opinion pulmonary medicine, 2004. 10,176-82 Determining Severity • Criteria for diagnosis of severe ARI requiring hospitalization included one or more of the following – Tachypnoea – Chest retractions – Cyanosis – Convulsions – Inability to drink Sunakorn, P., et al. Pediatr Infect Dis J, 1990. 9(12): 873-7 Case Definition • • • • Smallest number of criteria Fever not always present and not specific Auscultation not reliable in children Respiratory rate is the corner stone of diagnosis – Confirmed by many studies performed across the developing world Technical basis for the WHO recommendations on the management of pneumonia in children at first-level health facilities, 1991 Unwell child or infant with cough or difficulty in breathing Count respiratory rate over 1 minute Does the infant have indrawing of the chest wall? Yes No Pneumonia Yes Does the infant have any of the following? Central cyanosis off oxygen Severe respiratory distress Inability to drink No Very Severe Pneumonia Severe Pneumonia Adults Pneumonia CURB – 65 Scoring System • Six point scoring system (0-5), giving one point for each of the following – Confusion – Urea >7 mmol/l – RR ≥ 30/min – Low BP – Age ≥ 65 • A score of three or more is significant • Sensitivity and specificity of about 80% WS Lim et al Thorax 2003;58: 377-382 CRB - 65 • Further modification for use in the community • Excellent correlation with CURB - 65 Fever (≥38°C), cough and abnormal chest findings Pneumonia Score one for each clinical features Confusion Respiratory Rate over 1 minute > 30 Diastolic Pressure <60mmHg Age > 65 years 3-4 1-2 0 Severe Pneumonia Moderate Pneumonia Pneumonia