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Lack of Predictive Value of Tachypnea in the Diagnosis of Pneumonia in Children

Shah, Sonal MD, MPH*; Bachur, Richard MD; Kim, Daniel BS; Neuman, Mark I. MD, MPH

The Pediatric Infectious Disease Journal: May 2010 - Volume 29 - Issue 5 - p 406-409
doi: 10.1097/INF.0b013e3181cb45a7
Original Studies

Background: The World Health Organization (WHO) recommends the use of tachypnea as a proxy to the diagnosis of pneumonia in resource poor settings.

Objective: To assess the relation between tachypnea and radiographic pneumonia among children evaluated in a pediatric emergency department (ED).

Methods: Prospective study of children less than 5 years of age undergoing chest radiography (CXR) for possible pneumonia was conducted in an academic pediatric ED. Tachypnea was defined using 3 different measurements: (1) mean triage respiratory rate (RR) by age group, (2) age-defined tachypnea based on WHO guidelines (<2 months [RR ≥60/min], 2 to 12 months [RR ≥50], 1 to 5 years [RR ≥40]), and (3) physician-assessed tachypnea based on clinical impression assessed before CXR. The presence of pneumonia on CXR was determined by an attending radiologist.

Results: A total of 1622 patients were studied, of whom, 235 (14.5%) had radiographic pneumonia. Mean triage RR among children with pneumonia (RR = 39/min) did not differ from children without pneumonia (RR = 38/min). Twenty percent of children with tachypnea as defined by WHO age-specific cut-points had pneumonia, compared with 12% of children without tachypnea (P < 0.001). Seventeen percent of children who were assessed to be tachypneic by the treating physician had pneumonia, compared with 13% of children without tachypnea (P = 0.07).

Conclusion: Among an ED population of children who have a CXR performed to assess for pneumonia, RR alone, and subjective clinical impression of tachypnea did not discriminate children with and without radiographic pneumonia. However, children with tachypnea as defined by WHO RR thresholds were more likely to have pneumonia than children without tachypnea.

From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA; and †Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA.

Accepted for publication November 11, 2009.

The authors do not have any related affiliations or financial agreements.

Presented in part at the Pediatric Academic Societies Meeting in Baltimore, MD, May 2009.

The authors have agreed to the submission of this manuscript and take responsibility for its contents. This work has not been published in any other form and will not be submitted elsewhere while under consideration. All authors have participated in all of the following: study concept and design and data acquisition, analysis, and interpretation. The final manuscript was carefully reviewed and approved by all of the authors.

Address for correspondence: Sonal Shah, MD, MPH, Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Medical Center, 88 East Newton St, Vose Hall, 529 Boston, MA 02118. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.