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Published on: February 23, 2014
Risk of Hospitalization in Under-five Children With Community-Acquired Pneumonia: A Multicentric Prospective Cohort
Javeed Iqbal Bhat1, Bashir A Charoo2, Aparna Mukherjee3
1Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir. Correspondence to: Dr Javeed Iqbal Bhat, Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. drjaveediqbal@gmail.com.
Insights
Low oxygen saturation, elevated procalcitonin, and poor weight for height predict hospitalization risk in children with community-acquired pneumonia (CAP). These findings aid in assessing the need for inpatient care for pediatric CAP cases.
Area of Science:
- Pediatric Medicine
- Infectious Diseases
- Respiratory Health
Background:
- Community-acquired pneumonia (CAP) is a significant cause of childhood illness and hospitalization globally.
- Identifying risk factors for severe CAP is crucial for timely and appropriate medical intervention.
Purpose of the Study:
- To identify clinical and laboratory factors associated with hospitalization risk in children diagnosed with CAP.
- To provide evidence-based criteria for assessing the need for hospitalization in pediatric CAP patients.
Main Methods:
- A prospective, multi-site, hospital-based cohort study was conducted.
- The revised World Health Organization (WHO) case definition for acute respiratory infection (ARI) was used for patient enrollment (children aged 2-59 months).
- Clinical data, examination findings, and investigations, including oxygen saturation (SpO2) and procalcitonin levels, were recorded.
Main Results:
- Out of 7026 enrolled ARI patients, 938 (13.4%) were diagnosed with pneumonia.
- Hospitalization was required for 56.8% of children with pneumonia.
- Multivariate analysis identified SpO2 <92% in room air (OR 7.04), procalcitonin >0.5 ng/mL (OR 7.5), and lower weight-for-height z-score (OR 0.8) as significant predictors of hospitalization.
Conclusions:
- Oxygen saturation below 92%, serum procalcitonin levels above 0.5 ng/mL, and a lower weight-for-height z-score are key predictors of hospitalization risk in young children with CAP.
- These identified factors can assist healthcare providers in determining the necessity of hospitalization for children presenting with CAP.
Objective:
To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP).
Design:
Prospective cohort study.
Setting:
Multi-site hospital based study.
Intervention:
A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2-59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day).
Main Outcome Measure:
Risk factors for hospitalization among pneumonia patients.
Results:
A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multi-variate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, P=0.01), procalcitonin level >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95% CI: 0.6, 0.9, P=0.02).
Conclusion:
Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.
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