Online Program

Think global –act local: High pediatric occult pneumonia rates in Israel may suggest different guidelines for obtaining a chest x-ray than in the United States

Wednesday, November 6, 2013 : 1:32 p.m. - 1:50 p.m.

Jason Gruener, BA, MD Program, Icahn School of Medicine at Mount Sinai, New York, NY
Deena Rachel Zimmerman, MD, MPH, Research Department, Terem Emergency Medical Centers, Jerusalem, Israel
Nahum Kovalski, MDCM, Information Department, Terem Emergency Medical Centers, Jerusalem, Israel
Background: The prevalence of occult pneumonia within a pediatric population shapes clinical guidelines regarding the use of chest radiography in children with fever but no other clinical signs of pneumonia. In Israel, where routine anti-pneumococcal immunization was slower to be introduced than in the United States, a 2006 study revealed a 20.6% prevalence, suggesting that chest x-rays may still be indicated in children presenting with fever alone. In this study, using 2010 data, we sought to determine the frequency of pediatric occult pneumonia in Israel since the introduction of the vaccine. Methods: Charts were reviewed for 957 random patients between age 2 months and 10 years who presented to an urgent care center in Jerusalem in 2010 with a chief complaint of fever or respiratory symptoms and had a chest x-ray performed. Data collected included radiologist interpretation of the chest x-ray, significant respiratory findings (tachypnea, decreased air entry, rales, hypoxia), and demographic information. Results: The overall percentage of occult pneumonia was 12.3% (95% CI:10.4-14.6). Under age two, the rate was 10.7% (CI: 8.5-13.6). The rate for those between the ages of 2-5 years was 14.0% (CI: 10.3-18.7). For those ages 5-10 years, the rate was 16.0% (CI: 10.7-23.3). Conclusions: The prevalence of occult pneumonia in Israel suggests that chest x-ray is still an important tool in the search for fever without clinically obvious source, contrary to United States guidelines, where prevalence is lower. The age related changes may reflect the beginning of the effect of anti-pneumococcal vaccination.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Identify the prevalence of pediatric occult pneumonia in Israel in 2010. Explain how the prevalence rate of occult pneumonia can impact clinical decision-making. Describe one hypothesis for age-specific differences in pediatric occult pneumonia rates in Israel.

Keyword(s): Infectious Diseases, International Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical student who recently completed coursework in clinical epidemiology. I have spent much of the last year working on research related to the diagnosis of pneumonia in both emergency department and urgent care settings.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Gilead Sciences n/a Stock Ownership

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.