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Childhood pneumonia: clinical aspects associated with hospitalization or death
Cristiana M C Nascimento-Carvalho1, Heonir Rocha, Rogério Santos-Jesus
1Department of Pediatrics, Faculty of Medicine, Professor Hosannah de Oliveira Pediatric Center, Federal University of Bahia, Salvador, Brazil. nascimentocarvalho@hotmail.com
Insights
In children with pneumonia, ER visits indicate that young age, malnutrition, and chronic illness are key factors for hospitalization and death. Prompt assessment of these clinical signs is crucial for effective management.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Epidemiology
Background:
- Pneumonia is a leading cause of childhood mortality globally.
- Accurate risk stratification in the Emergency Room (ER) is vital for timely intervention in pediatric pneumonia cases.
- Identifying predictors of severe outcomes can improve patient management and resource allocation.
Purpose of the Study:
- To identify clinical factors available during an Emergency Room (ER) consultation that predict hospitalization or death in children diagnosed with pneumonia.
Main Methods:
- A prospective cohort study was conducted in the ER departments of one university and one private hospital.
- Stepwise logistic regression analysis was employed to evaluate factors associated with severe outcomes.
- Data from 2,970 pediatric pneumonia cases were analyzed.
Main Results:
- 25.8% of children were hospitalized, and 0.8% died.
- Factors associated with hospitalization included young age, malnutrition, underlying chronic illness, tachypnea, chest indrawing, and somnolence.
- Independent predictors of death were young age, malnutrition, and underlying chronic illness.
Conclusions:
- Clinical signs such as young age, malnutrition, chronic illness, tachypnea, chest indrawing, and somnolence are important indicators for ER hospitalization decisions in pediatric pneumonia.
- Intrinsic factors like age, malnutrition, and chronic illness are independently linked to mortality risk.
- Pneumonia is a treatable condition, with most children achieving full recovery when managed appropriately.
Objective:
To determine which available information at an Emergency Room (ER) consultation is associated with hospitalization or death among children with pneumonia.
Design:
Prospective cohort study.
Setting:
The ER of one university and one private hospital.
Measurement:
Using stepwise logistic regression we analyzed factors that showed a univariate association.
Main Results:
Of 2,970 cases, the median age was 1.83 years (range 2 days to 14.5 yrs, mean 2.76 +/- 2.72 yrs); 25.8% were hospitalized and 0.8% died. Age (2-11 mos, OR 0.4 [0.2-0.6]; 12-59 mos, OR 0.2 [0.1-0.4]; > or = 5 yrs, OR 0.1 [0.08-0.3]), malnutrition (OR 2.0 [1.4-2.7]), underlying chronic illness (OR 1.4 [1.1-1.8]), tachypnea (OR 1.8 [1.4-2.4]), chest indrawing (OR 1.7 [1.4-2.2]), and somnolence (OR 1.8 [1.4-2.4]) were associated with hospitalization and age (2-11 mos, OR 0.3 [0.08-0.8]; > or = 12 mos, OR 0.06 [0.02-0.2]), malnutrition (OR 3.1 [1.2-7.7]) and underlying chronic illness (OR 4.3 [1.6-11.0]) were associated with death in the multivariate analysis.
Conclusions:
Several clinical aspects may be used in assessing need for hospitalization (i.e. young age, malnutrition, underlying chronic illness, tachypnea, chest indrawing and somnolence) for children with pneumonia seen at the ER. Individual intrinsic factors such as age, malnutrition and underlying chronic illness were independently associated with death. Pneumonia should be considered a treatable disease and complete recovery can be achieved in the majority of the cases.