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Commentary
Primary care
Hypoxia and signs of increased work of breathing are most strongly associated with radiographic pneumonia in children
  1. Heather J Zar
  1. Correspondence to Professor Heather J Zar, Department of Paediatrics and Child Health, SAMRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town 7700, South Africa; Heather.Zar{at}uct.ac.za

https://doi.org/10.1136/bmjebm-2017-110874

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    Commentary on: Shah SN, Bachur RG, Simel DL, et al. Does this child have pneumonia?: the rational clinical examination systematic review. JAMA 2017;318:462–471.

    Context

    Pneumonia remains the predominant cause of childhood mortality beyond the neonatal period.1 Despite the high burden and severity of disease, reliable, feasible reference standards for diagnosis are elusive. Diagnosis in primary care rests on clinical signs, predominantly tachypnoea or lower chest retractions, as contained in WHO guidelines; these signs are sensitive but non-specific.2 This systematic review investigated the accuracy of symptoms and signs to identify children with radiographic pneumonia.

    Methods

    This was a systematic review of studies from 1956 to May 2017 of the accuracy of symptoms and clinical signs for diagnosis of paediatric pneumonia as defined by radiographic disease.3 Studies included children <5 years, presentation with suspected pneumonia …

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