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Updated: Mar 30, 2026
Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Association of Systemic Inflammatory Response Syndrome with Clinical Outcomes of Pediatric Patients with Pneumonia
Steven Barron Frazier1, Robert Sepanski1, Christopher Mangum1
1From the Department of Pediatrics, Children's Hospital of the King's Daughters/Eastern Virginia Medical School, Norfolk.
Insights
Systemic inflammatory response syndrome (SIRS) in children with pneumonia indicates more severe illness. Identifying SIRS in the emergency department can help pinpoint children needing closer monitoring and advanced treatment for better outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Infectious Diseases
Background:
- Systemic inflammatory response syndrome (SIRS) is a potential complication of pneumonia in children.
- The presence of SIRS suggests increased pneumonia severity and may warrant closer clinical evaluation.
- Early identification of SIRS in pediatric pneumonia patients is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between SIRS and adverse clinical outcomes in children with community-acquired pneumonia.
- To evaluate the utility of SIRS as an indicator for identifying high-risk pediatric pneumonia patients in the emergency department.
Main Methods:
- Retrospective chart review of 276 children diagnosed with community-acquired pneumonia in a pediatric emergency department.
- SIRS criteria adapted from the International Consensus Conference on Pediatric Sepsis, considering age-adjusted vital signs and white blood cell counts.
- Morbidity endpoints included hospital admission, ED return, need for surgery, mechanical ventilation, and length of hospital stay.
Main Results:
- Children with SIRS (n=38) showed significantly higher rates of hospital admission or ED return (79% vs. 34.5%) compared to SIRS-negative patients (n=238).
- SIRS-positive pediatric pneumonia patients had a greater risk of requiring video-assisted thoracoscopic surgery (18.4% vs. 0.8%) and mechanical ventilation (10.5% vs. 0.8%).
- Median length of hospital stay was substantially longer for children with SIRS (2.7 days vs. 0.19 days).
Conclusions:
- SIRS in pediatric community-acquired pneumonia is strongly associated with more severe disease and adverse clinical outcomes.
- Implementing a sepsis screening tool to identify SIRS in pediatric pneumonia patients in the ED can aid in recognizing those needing intensive management.
- This approach may improve patient stratification and resource allocation for children with severe pneumonia.
Objectives:
Systemic inflammatory response syndrome (SIRS) may complicate pneumonia. When present, it suggests that the patient's pneumonia is more severe. As such, recognition of SIRS among patients with pneumonia may be helpful in identifying those requiring more careful evaluation. Our objective was to examine the relation between the presence of SIRS and adverse clinical outcomes among children with pneumonia seen in the emergency department (ED).
Methods:
A retrospective chart review was performed on children diagnosed as having community-acquired pneumonia who presented to a children's hospital ED during a 3-month period. SIRS was determined by using a modification of the International Consensus Conference on Pediatric Sepsis criteria. Specifically, the SIRS criteria require an abnormal temperature-corrected heart rate or respiratory rate and either an abnormal temperature or white blood cell count. The threshold for abnormal vital signs and white blood cell counts used to determine SIRS was adjusted based on the patient's age. Morbidity endpoints included progression to inpatient or observation status or subsequent return to the ED for pneumonia, need for video-assisted thoracoscopic surgery, and total hospital length of stay as measured from ED triage assessment to final discharge from the hospital (ED, observation, or inpatient), and the need for mechanical ventilation.
Results:
A total of 276 children were included in the analysis. Pneumonia patients with SIRS (n = 38) had a greater rate of hospital admission or ED return compared with SIRS-negative patients (n = 238; 79% vs 34.5%, respectively; P < 0.0001). Children with SIRS-positive pneumonia were at greater risk of requiring video-assisted thoracoscopic surgery (18.4% vs 0.8%; P < 0.0001). In addition, pneumonia patients with SIRS had a significantly longer median length of stay compared with pneumonia patients without SIRS (2.7 vs 0.19 days, P < 0.0001) and also had a significantly higher risk of mechanical ventilation (10.5% vs 0.8%).
Conclusions:
SIRS in children with community-acquired pneumonia is associated with a significantly higher likelihood of experiencing a more adverse outcome. Based on these observations, a sepsis screening tool in the ED that identifies SIRS in children with pneumonia has the potential to identify those children needing more intense monitoring and treatment.
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