Article Text

Adding fever to WHO criteria for diagnosing pneumonia enhances the ability to identify pneumonia cases among wheezing children
  1. Maria-Regina A Cardoso1,
  2. Cristiana M Nascimento-Carvalho2,
  3. Fernando Ferrero3,
  4. Fátima M Alves4,
  5. Simon N Cousens5
  1. 1Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
  2. 2Department of Paediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil
  3. 3Hospital de Niños Elizalde, Buenos Aires, Argentina
  4. 4Secretariat of Health of the State of São Paulo, São Paulo, Brazil
  5. 5Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Professor Maria-Regina A Cardoso, Department of Epidemiology, Faculty of Public Health, University of São Paulo, Av. Dr. Arnaldo 715, São Paulo CEP 01246-904, Brazil; rcardoso{at}


Objective To examine the ability of the criteria proposed by the WHO to identify pneumonia among cases presenting with wheezing and the extent to which adding fever to the criteria alters their performance.

Design Prospective classification of 390 children aged 2–59 months with lower respiratory tract disease into five diagnostic categories, including pneumonia. WHO criteria for the identification of pneumonia and a set of such criteria modified by adding fever were compared with radiographically diagnosed pneumonia as the gold standard.

Results The sensitivity of the WHO criteria was 94% for children aged <24 months and 62% for those aged ≥24 months. The corresponding specificities were 20% and 16%. Adding fever to the WHO criteria improved specificity substantially (to 44% and 50%, respectively). The specificity of the WHO criteria was poor for children with wheezing (12%). Adding fever improved this substantially (to 42%). The addition of fever to the criteria apparently reduced their sensitivity only marginally (to 92% and 57%, respectively, in the two age groups).

Conclusion The authors' results reaffirm that the current WHO criteria can detect pneumonia with high sensitivity, particularly among younger children. They present evidence that the ability of these criteria to distinguish between children with pneumonia and those with wheezing diseases might be greatly enhanced by the addition of fever.

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  • Funding This research was funded by the International Development Research Centre (IDRC) – Canada.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of São Paulo.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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