Table 1.

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

Study	Site	Sample size	Gold standard pneumonia definition	Clinical signs/symptoms investigated	Conclusions regarding definition
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%

CXR, chest radiograph; RR, respiratory rate

Reproduced from Scott et al [33]