Chan FYY, et al. - Researchers conducted a multicenter prospective study in 3 emergency departments for derivation and validation of the Pediatric Acute Febrile Respiratory Illness rule (PAFRI Rule), a decision rule to assist judgment on the need of ordering a chest radiograph. They assessed 967 children; of these, 530 had undergone chest radiograph examination; radiograph yielded evidence of pneumonia in 91. Derivation of PAFRI Rule was done from logistic regression with 5 weighed predictors: span of fever < 3 days (0 points), 3–4 days (2 points), 5–6 days (4 points), ≥ 7 days (5 points), chills (2 points), nasal symptoms (−2 points), abnormal chest examination (3 points), SpO2 ≤ 96% or tachypnea (3 points). A sensitivity of 91.7% and a negative predictive value of 97.7% were achieved with a PAFRI score of ≥ 0. Findings thus support the possible utility of PAFRI rule as a reference tool for guiding the need for taking Chest radiograph examination for pediatric patients.