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Recommendations for Pneumonia in Hospitalized Children With Neurologic Impairment
Joanna E Thomson1,2,3, Abigail Musial1,3,4, Rebecca Steuart5,6
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
This study provides expert-endorsed recommendations for hospitalized children with neurologic impairment (CNI) and pneumonia. The guidelines focus on appropriate diagnosis, treatment, airway clearance, and discharge to improve care for this vulnerable population.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Children with neurologic impairment (CNI) frequently require hospitalization for pneumonia.
- Existing clinical practice guidelines often exclude CNI, leaving a gap in evidence-based care.
- There is a need for tailored recommendations for managing pneumonia in CNI.
Purpose of the Study:
- To develop evidence-based, expert-panel endorsed recommendations for the care of children with neurologic impairment hospitalized with pneumonia.
- To address diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria.
- To provide guidance for a population often excluded from standard guidelines.
Main Methods:
- Conducted an extensive literature search to inform candidate recommendations.
- Convened a national expert panel including pediatric specialists and family advocates.
- Utilized the RAND/University of California Los Angeles Appropriateness Method with two rounds of panelist ratings.
Main Results:
- Assessed 73 drafted recommendations for pneumonia management in CNI.
- Achieved consensus on 72 recommendations after minor modifications.
- Recommendations emphasize minimizing broad-spectrum antibiotics and promoting collaboration with therapists, families, and outpatient providers.
- Guidelines account for patient heterogeneity, comorbidities, aspiration risk, and illness severity.
Conclusions:
- Developed comprehensive recommendations for the appropriate diagnosis, treatment, airway clearance, and discharge of CNI hospitalized with pneumonia.
- These recommendations can inform clinical practice for this specific patient group.
- Further research is needed to evaluate the impact of these recommendations on patient- and family-centered outcomes.
Objectives:
Children with neurologic impairment (CNI) are commonly hospitalized with pneumonia but are often excluded from practice guidelines. We sought to develop evidence-based, expert-panel endorsed recommendations for the care of CNI hospitalized with pneumonia.
Methods:
We conducted an extensive literature search that formed the basis of drafted candidate recommendations for diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria. We convened a national panel of individuals with expertise in nursing, pediatric medicine (infectious diseases, pulmonology, hospital medicine, complex care), and family advocacy. Using the RAND/University of California Los Angeles Appropriateness Method, including a moderated panel meeting, panelists rated recommendations for appropriateness in 2 sequential rounds.
Results:
The panel assessed 73 drafted recommendations for diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria for CNI hospitalized with pneumonia. After modifications to 2 of the drafted recommendations, the panel reached agreement on the appropriateness of 72 recommendations. Recommendations include management that minimizes the use of broad-spectrum antibiotics. Recommendations further emphasize collaboration with respiratory therapists for airway clearance and with families, outpatient managing physicians, and homecare providers for discharge. The recommendations for pneumonia diagnosis and management account for heterogeneity in the patient population, including comorbidities and risk factors (eg, aspiration risk), as well as severity of presenting illness.
Conclusion:
Recommendations for appropriate diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria for CNI hospitalized with pneumonia can be used to inform clinical care. The effect of these recommendations on patient- and family-centered outcomes should be studied.
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