Picard et al evaluated pediatric patients with pneumonia and parapneumonic effusion/empyema. They identified factors predictive for a prolonged fever. The authors are from Shaare Zedek Medical Center and Hebrew University in Jerusalem.
Patient selection: pediatric patient < 16 years old with pneumonia and parapneumonic effusion
Outcome: fever lasting > 7 days
Parameters:
(1) platelet count
(2) pleural fluid pH
(3) ratio of pleural to serum LDH concentrations
(4) ratio of pleural to serum glucose concentrations
|
Parameter
|
Finding
|
Points
|
|
platelet count
|
> 400,000 per µL
|
3
|
|
|
150,000 to 400,000
|
2
|
|
|
< 150,000 per µL
|
1
|
|
pleural fluid pH
|
> 7.4
|
3
|
|
|
7.2 to 7.4
|
2
|
|
|
< 7.2
|
1
|
|
LDH ratio
|
< 20
|
3
|
|
|
20 to 40
|
2
|
|
|
> 40
|
1
|
|
glucose ratio
|
> 0.8
|
3
|
|
|
0.2 to 0.8
|
2
|
|
|
< 0.2
|
1
|
fever duration score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 4
• maximum score: 12
• A score < 8 was associated with fever > 7 days.
Additional predictors of prolonged fever:
(1) positive blood culture
(2) positive pleural fluid culture
(3) underlying disease (prematurity, congenital heart disease, thalassemia minor, failure to thrive, Down's syndrome, renal disease)
Performance:
• The sensitivity was 91% and specificity 47%.
