Consensus Definition for Community-acquired Pneumonia in Children Using a Delphi Approach

Abstract

Background: Although community-acquired pneumonia (CAP) is one of the most common infections in children, no standardized criteria for diagnosis exist. The objective of this study was to develop expert consensus for the diagnosis of pediatric CAP in countries with a high level of access to health care. Methods: Using a web-based classic Delphi approach, a multidisciplinary panel of childhood pneumonia experts rated clinical, radiographic and laboratory criteria relevant to pediatric pneumonia diagnosis. Round 1 was open-ended, with panelists freely stating all characteristics they thought defined pneumonia. In round 2, panelists were asked to select variables from the first round and to rank the 10 features from most to least important. In round 3, panelists selected the most relevant association of criteria resulting from the round 2 results. Finally, consensus was defined as at least 80% agreement. Results: Thirty-three participants completed the study. Thirty-one variables were obtained from the first round. In the second round, the 10 most pertinent variables according to the experts were fever, tachypnea, radiologic consolidation site, focal crackles, alteration of general condition, cough, C-reactive protein (CRP) >80 mg/L, ultrasound parenchymal consolidation, decreased breath sounds and asymmetric breath sounds. Expert consensus for the diagnosis of pneumonia was reached on the association consisting of 3 major (fever, tachypnea and radiologic focal consolidation) and 3 out of 5 minor (focal crackles, CRP >80 mg/L, altered general condition, cough, and pulmonary consolidation syndrome) criteria. Conclusions: Our study has provided a definition of presumed CAP in children suitable for routine practice and routine clinical research in countries with a high level of health care.