Acute Respiratory Infections Case Definitions

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Acute Respiratory InfectionsCase Definitions

• Dr Claudia Turner
• Research Paediatrician
• SMRU

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Case Definitions

• Pneumonia
• Children Infants
• Adults
• Avian Influenza

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Children and Infants

• Pneumonia

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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
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Diagnosis of Pneumonia in Children

• The presence of either a RR gt50 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
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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
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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
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Unwell child or infant with cough or difficulty
in breathing
Count respiratory rate over 1 minute
No
Does the infant have indrawing of the chest wall?
Pneumonia
Yes
Does the infant have any of the
following? Central cyanosis off oxygen Severe
respiratory distress Inability to drink
No
Yes
Very Severe Pneumonia
Severe Pneumonia
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Adults

• Pneumonia

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CURB 65 Scoring System

• Six point scoring system (0-5), giving one point
  for each of the following
• Confusion
• Urea gt7 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 200358 377-382
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CRB - 65

• Further modification for use in the community
• Excellent correlation with CURB - 65

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Fever (38C), cough and abnormal chest findings
Pneumonia
Score one for each clinical features
Confusion Respiratory Rate over 1 minute gt
30 Diastolic Pressure lt60mmHg Age gt 65 years
0
3 - 4
1 - 2
Severe Pneumonia
Pneumonia
Moderate Pneumonia