Hay et al reported the STARWAVe pneumonic to aid in appropriate use of antibiotics in a pediatric patient with an acute respiratory infection and cough. The authors are from the University of Bristol, University of Southampton, Southmead Hospital (Bristol) and the University of Washington (Seattle).

Patient selection: pediatric patient from 3 months to 16 years with a respiratory infection and cough


Outcome: outpatient antibiotic therapy to reduce risk of hospital admission


S: short illness (<= 3 days)

T: temperature >= 37.8°C at presentation or parent-reported severe fever in past 24 hours

A: age < 2 years

R: recession of intercostal or subcostal areas on clinical exam

W: wheeze on auscultation

A: asthma, current

V: vomiting moderate or severe in the previous 24 hours


Each item was scored 1 point if present and 0 if absent.


total score =

= SUM(points for all 7 items)



minimum score: 0

maximum score: 7

The higher the score the more likely that the child would be admitted to the hospital.

A child considered low risk for hospital admission may not benefit from antibiotic therapy.



Risk of Hospital Admission

0 or 1

low (0.3%)

2 or 3

normal (1.5%)

4 to 7

high (16%)



The area under the ROC curve is 0.82.

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