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A population-based analysis of children with pneumonia among intensive care units in Taiwan
Chien-Lun Hsu1, Yu-Sheng Lee2, Chun-Jen Chen1
1Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
Insights
Pediatric pneumonia requiring intensive care is more common in younger children but has a lower fatality rate. Older children with pneumonia face higher mortality risks, often linked to invasive procedures.
Area of Science:
- Pediatric critical care medicine
- Epidemiology of childhood diseases
- Respiratory medicine
Background:
- Pneumonia is a leading cause of mortality in critically ill children.
- Understanding current epidemiology and risk factors is vital for improving care.
- Intensive care unit (ICU) management of pediatric pneumonia requires specific data.
Purpose of the Study:
- To analyze the epidemiology of pediatric pneumonia in ICUs.
- To identify factors associated with case fatality in critically ill children with pneumonia.
- To investigate the association between invasive procedures and mortality.
Main Methods:
- Retrospective analysis of pediatric pneumonia cases (under 18) admitted to ICUs from 2006-2010 in Taiwan using the NHIRD.
- Children were stratified into age groups: 0-2, 3-5, 6-11, and 12-17 years.
- Association of invasive procedures (ET/MV, CVC, ECMO, chest tube) with case fatality was analyzed.
Main Results:
- 12,577 children were enrolled; 56.7% were boys.
- Younger children (0-2 years) had more cases but lower fatality rates (3.1%) and less need for invasive procedures (31.1%).
- Older children (12-17 years) had higher fatality rates (9.9%) and greater need for invasive procedures (59.8%). Invasive procedures like ET/MV, CVC, ECMO, and chest tube insertion were significantly associated with increased case fatality.
Conclusions:
- Pediatric pneumonia ICU admissions are more frequent in younger children.
- Higher case fatality rates in pediatric pneumonia are associated with older age, need for invasive procedures (ET/MV, CVC, chest tube, ECMO), comorbidities, and complications.
- Targeted interventions for older children and careful consideration of invasive procedures are crucial for reducing mortality.
Background:
Pneumonia is a major diagnosis in children that requires intensive care and is a major cause of mortality in critically ill children. A survey on current epidemiology and case fatality-associated conditions is crucial for the care of critically ill children with pneumonia in an intensive care unit (ICU).
Methods:
The sex, age, seasonality of admission, area of distribution, and case fatality rate of children younger than 18 years who had pneumonia and were admitted to an ICU during the period 2006-2010 were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan. The enrolled children were grouped by age (0-2 years, 3-5 years, 6-11 years, and 12-17 years). The need for invasive procedures such as endotracheal tube (ET) insertion, mechanical ventilation (MV), tracheostomy, central venous catheter (CVC) insertion, chest tube insertion/drainage, chest surgery, and extracorporeal membranous oxygenation (ECMO) were analyzed to clarify their association with case fatality in critically ill children with pneumonia.
Results:
Of the 12,577 children enrolled, 7131 (56.7%) were boys and 5446 (43.3%) were girls. The younger age groups had more cases of pneumonia, but less often required invasive procedures. Children 0-2 years old (n = 6083) accounted for approximately one-half (48.4%) of all enrolled children. This group had the lowest case fatality rate (3.1%; 187/6083 children) and lowest need for invasive procedures (31.1%; 1892/6083 children), whereas children in the 12-17 year-old group had the highest case fatality rate (9.9%; 140/1417 children) and the highest need for invasive procedures (59.8%; 847/1417 children) (p < 0.001). The percentage of pneumonia cases was highest in the spring (30.1%) and lowest in the summer (21.7%). The invasive procedures associated with case fatality were ET/MV (OR, 14.31; p < 0.001), CVC insertion (OR, 7.46; p < 0.001), ECMO intervention (OR, 4.59; p < 0.001), and chest tube insertion/drainage (OR, 1.87; p < 0.001).
Conclusion:
The number of cases of pneumonia that required ICU admission was greater among younger children than among older children. Factors associated with the higher case fatality rate included older age at presentation, the need for invasive procedures (e.g., ET/MV, CVC insertion, chest tube insertion/drainage, and ECMO), underlying comorbidities and complications.
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