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Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks
Todd Adam Florin1, Daniel Joseph Tancredi2, Lilliam Ambroggio3
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA taflorin@luriechildrens.org.
Insights
This study aims to create a clinical prediction model for children with community-acquired pneumonia (CAP) to better assess disease severity in emergency departments (EDs) globally. This tool will aid physicians in making crucial management and disposition decisions for pediatric pneumonia patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Epidemiology
- Health Services Research
Background:
- Community-acquired pneumonia (CAP) is a significant cause of pediatric emergency department (ED) visits and hospitalizations.
- Current management and disposition decisions for pediatric CAP in the ED lack evidence-based, validated tools.
- Accurate risk stratification is crucial for appropriate resource allocation and patient care.
Purpose of the Study:
- To develop and validate a clinical prediction model for stratifying pediatric CAP severity.
- To identify children at risk for low, moderate, and severe disease presentations in the ED.
- To create a globally generalizable tool for use in diverse ED settings.
Main Methods:
- Prospective cohort study enrolling up to 4700 children (3 months to <14 years) with CAP across ~80 international ED sites.
- Collection of clinical, laboratory, and imaging data, along with follow-up surveys (7-14 days post-visit).
- Development of risk stratification models using ordinal logistic regression and recursive partitioning.
Main Results:
- The study will yield a validated clinical prediction model for pediatric CAP severity.
- The model aims for accurate risk stratification across a global network of EDs.
- Findings will enable improved decision-making for children presenting with CAP.
Conclusions:
- The developed model will provide an evidence-based tool for ED physicians managing pediatric CAP.
- This tool will enhance the accuracy of disease severity assessment and guide disposition decisions.
- The study's global scope ensures broad generalizability and potential for widespread clinical implementation.
Introduction:
Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.
Methods And Analysis:
This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7-14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.
Ethics And Dissemination:
This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children's Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.
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