• Bonnie Mathews, Sonal Shah, Robert H Cleveland, Edward Y Lee, Richard G Bachur, and Mark I Neuman.
• Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
• Pediatrics. 2009 Jul 1; 124 (1): e29-36.

ObjectiveThe goal was to identify factors associated with radiographically confirmed pneumonia among children with wheezing in the emergency department (ED) setting.MethodsA prospective cohort study was performed with children ResultsA total of 526 patients met the inclusion criteria; the median age was 1.9 years (interquartile range: 0.7-4.5 years), and 36% were hospitalized. A history of wheezing was present for 247 patients (47%). Twenty-six patients (4.9% [95% confidence interval [CI]: 3.3-7.3]) had radiographic pneumonia. History of fever at home (positive likelihood ratio [LR]: 1.39 [95% CI: 1.13-1.70]), history of abdominal pain (positive LR: 2.85 [95% CI: 1.08-7.54]), triage temperature of >or=38 degrees C (positive LR: 2.03 [95% CI: 1.34-3.07]), maximal temperature in the ED of >or=38 degrees C (positive LR: 1.92 [95% CI: 1.48-2.49]), and triage oxygen saturation of <92% (positive LR: 3.06 [95% CI: 1.15-8.16]) were associated with increased risk of pneumonia. Among afebrile children (temperature of <38 degrees C) with wheezing, the rate of pneumonia was very low (2.2% [95% CI: 1.0-4.7]).ConclusionsRadiographic pneumonia among children with wheezing is uncommon. Historical and clinical factors may be used to determine the need for chest radiography for wheezing children. The routine use of chest radiography for children with wheezing but without fever should be discouraged.

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