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Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Paediatric pneumonia: deriving a model to identify severe disease
Stuart Haggie1, Elizabeth H Barnes2, Hiran Selvadurai3
1The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, New South Wales, Australia stuart.haggie@gmail.com.
Insights
This study identified key risk factors for severe community-acquired pneumonia (CAP) in children, including hypoxia and comorbidities. A new clinical tool effectively predicts severe CAP, aiding in risk stratification for pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Community-acquired pneumonia (CAP) is a significant cause of pediatric hospitalizations.
- Limited data and tools exist for predicting severe CAP in children.
- There is a need for pediatric-specific predictive tools for CAP severity.
Purpose of the Study:
- To identify clinical factors predicting severe outcomes in hospitalized children with CAP.
- To develop and validate a clinical risk prediction tool for severe pediatric CAP.
- To stratify children at risk for invasive or intensive care interventions.
Main Methods:
- Retrospective cohort study of 3330 hospitalized CAP cases (2011-2016).
- Analysis of clinical variables at hospital presentation against stratified outcomes (mild, moderate, severe).
- Development and validation of a clinical risk stratification tool using logistic regression and ROC analysis.
Main Results:
- Hypoxia, increased work of breathing, comorbidities, and indigenous status were associated with moderate-severe CAP outcomes.
- Febrile children had a lower likelihood of moderate-severe outcomes.
- The derived clinical tool achieved an AUC of 0.72 for predicting severe disease, with high scores indicating significantly increased odds of moderate-severe outcomes.
Conclusions:
- A clinical risk prediction tool is essential for managing pediatric CAP.
- Identified risk factors and a novel clinical tool can stratify children's risk of severe CAP.
- The developed tool demonstrates comparable performance to adult pneumonia prediction tools.
Background:
Community-acquired pneumonia (CAP) is a leading cause of childhood hospitalisation. Limited data exist on factors predicting severe disease with no paediatric-specific predictive tools.
Methods:
Retrospective cohort (2011-2016) of hospitalised CAP cases. We analysed clinical variables collected at hospital presentation against outcomes. Stratified outcomes were mild (hospitalised), moderate (invasive drainage procedure, intensive care) or severe (mechanical ventilation, vasopressors, death).
Results:
We report 3330 CAP cases, median age 2.0 years (IQR 1-5 years), with 2950 (88.5%) mild, 305 (9.2%) moderate and 75 (2.3%) severe outcomes. Moderate-severe outcomes were associated with hypoxia (SaO2 <90%; OR 6.6, 95% CI 5.1 to 8.5), increased work of breathing (severe vs normal OR 5.8, 95% CI 4.2 to 8.0), comorbidities (4+ comorbidities vs nil; OR 8.8, 95% CI 5.5 to 14) and being indigenous (OR 4.7, 95% CI 2.6 to 8.4). Febrile children were less likely than afebrile children to have moderate-severe outcomes (OR 0.57 95% CI 0.44 to 0.74). The full model receiver operating characteristic (ROC) area under the curve (AUC) was 0.78. Sensitivity analyses showed similar results with clinical or radiological CAP definitions. We derived a clinical tool to stratify low, intermediate or high likelihood of severe disease (AUC 0.72). High scores (≥5) had nearly eight times higher odds of moderate-severe disease than those with a low (≤1) score (OR 7.7 95% CI 5.6 to 10.5).
Conclusions:
A clinical risk prediction tool is needed for child CAP. We have identified risk factors and derived a simple clinical tool using clinical variables at hospital presentation to determine a child's risk of invasive or intensive care treatment with an ROC AUC comparable with adult pneumonia tools.
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