Table 1 Studies of pneumonia in children contributing to World Health Organization (WHO) clinical case definitions

Shann et al [28]

Goroka, Papua New Guinea

350

Crepitations on auscultaion

Age, RR, lower chest wall indrawing, cyanosis, wheeze, pulse rate, palpable liver, temperature >37.5°C, feeds poorly

RR >50/minute was the most accurate way to differentiate pneumonia from nonpneumonia

Cherian et al [29]

Vellore, Tamil Nadu, India

682

Crepitations, wheeze, bronchial breathing or radiological abnormalities

RR, parental report of rapid breathing, intercostal retraction

Refined the value of RR by age stratification to >50 for infants and >40 for children >12 months

Campbell et al [30]

Banjul, The Gambia

222 (episodes of illness in a cohort study)

Radiological signs (lobar consolidation)

Vomiting, rapid breathing, refusing to feed, chest indrawing, RR, nasal flaring, temperature, heart rate, crepitations, bronchial breathing or reduced air entry, rhonchi, grunting

Temperature >38.5°C, refusing to feed and vomiting were the most useful predictors of severe pneumonia in infants, whereas temperature >38.5°C and RR >60/minute were the most useful among children aged 1–4 years old

Mulholland et al [31]

Philippines, Swaziland

730

Complete history, physical examination by paediatrician, and CXR

Cough, difficulty breathing, chest wall indrawing, RR. Cases with wheeze excluded

Sensitivity and specificity for RR >40/minute or for lower chest wall indrawing were between 0.77 and 0.81 in 2 different settings, but specificity was lower when judged by a healthcare worker

Simoes and McGrath [32]

Mbabane, Swaziland

362

Paediatrician’s assessment on WHO criteria

Cough, difficulty breathing, ability to drink/feed well, convulsions, abnormal sleepiness, stridor, severe undernutrition, fever, wheeze, lower chest wall indrawing, tachypnoea, fever

Using RR and lower chest wall indrawing, nurses and nursing assistants detected 71%–83% of pneumonia cases with specificity of 84%–85%