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Published on: May 6, 2014
Management and outcomes of pneumonia among children with complex chronic conditions
JoAnna K Leyenaar1, Tara Lagu, Meng-Shiou Shieh
1From the *Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston; †Center for Quality of Care Research; ‡Division of General Internal Medicine, Baystate Medical Center, Springfield; §Department of Medicine, Tufts University School of Medicine, Boston; and ¶Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
Insights
Children with complex chronic conditions (CCC) hospitalized for pneumonia face worse outcomes and broader antibiotic use. Further research is needed to improve management and reduce adverse events in this vulnerable pediatric population.
Area of Science:
- Pediatric Hospital Medicine
- Infectious Diseases
- Health Services Research
Background:
- Pneumonia is a frequent cause of hospitalization in children with complex chronic conditions (CCC).
- Limited data exist on the specific treatment and outcomes for pediatric pneumonia in CCC patients.
- Understanding variations in antibiotic management and outcomes among CCC subgroups is crucial.
Purpose of the Study:
- To characterize the presentation, management, and outcomes of pneumonia in children with and without CCC.
- To describe how antibiotic management and outcomes differ among pediatric patients with various CCC subgroups.
Main Methods:
- A cohort study was conducted involving children under 18 years old diagnosed with pneumonia across numerous US hospitals.
- Children were categorized into different CCC subgroups for comparative analysis.
- Multivariable regression models were employed to assess differences in disease management and patient outcomes.
Main Results:
- Children with CCC represented 11.9% of the 31,684 pneumonia patients.
- CCC patients received more intensive investigations and therapies, with altered antibiotic choices (less aminopenicillins/cephalosporins, more broad-spectrum agents).
- Compared to non-CCC peers, CCC patients experienced longer hospital stays (RR 1.43), higher costs (RR 1.38), increased antibiotic escalation (OR 1.51), more complications (OR 1.47), and higher readmission rates (OR 4.0).
Conclusions:
- Children with CCC are a significant group hospitalized for pneumonia, facing substantially higher risks of adverse outcomes.
- These children frequently receive broad-spectrum antibiotics during and after hospitalization.
- Further research is essential to guide clinical decision-making and develop guidelines to minimize adverse events and management variability in pediatric CCC patients with pneumonia.
Introduction:
Although pneumonia is a common reason for pediatric hospitalization among children with complex chronic conditions (CCC), treatment and outcomes have not been well-described. We characterized the presentation, management and outcomes of pneumonia in children with and without CCC and described how antibiotic management and outcomes vary among subgroups of children with CCC.
Methods:
We conducted a cohort study of children <18 years with pneumonia across a large sample of US hospitals. Children were grouped according to CCC subgroups. Differences in disease management and outcomes were assessed using multivariable regression.
Results:
Of the 31,684 children in our cohort, 11.9% had CCC. Children with CCC were more likely to receive intensive investigations and therapies, were less likely to receive aminopenicillins or third generation cephalosporins and were more likely to receive antibiotics against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and anaerobes. Compared with children without these conditions, children with CCC had significantly increased length of stay [relative risk 1.43, 95% confidence interval (CI) 1.39-1.48] and hospital costs (relative risk 1.38, 95% CI 1.33-1.43), with increased odds of antibiotic escalation (odds ratio 1.51, 95% CI 1.35-1.70), pneumonia complications (odds ratio 1.47, 95% CI 1.24-1.75) and readmission (odds ratio 4.0, 95% CI 3.2-5.0).
Discussion:
Children with CCC comprise a significant proportion of children hospitalized for pneumonia and are at substantially increased risk of adverse outcomes. They have high rates of treatment with broad spectrum antibiotics, both at the time of hospitalization and subsequently. Research is needed to inform decision-making and guideline development, with goals of reducing adverse outcomes and unnecessary variation in management among children with CCC.
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