Clinical Outcomes of Children Meeting the At-Risk for PARDS Criteria Before PICU Admission: A Single-Center Study

To evaluate the ability of the criteria "At-risk for PARDS" to identify patients with acute respiratory infection hospitalized outside the pediatric intensive care unit (PICU) who are at high risk of developing pediatric acute respiratory distress syndrome (PARDS) and describe the timing for the identification. The secondary aim was to explore clinical outcome differences between patients with and without risk for PARDS.

We conducted an observational prospective cohort study from June to August 2019. Children under 15 years old hospitalized in a pediatric ward due to an acute respiratory tract infection were included.

A total of 177 patients with a median age of 12 (IQR 5; 25) months were included. Registered data included demographics, respiratory support, at-risk for PARDS and PARDS diagnosis according to PALICC consensus. PICU admission, hospital length of stay (LOS) and intrahospital mortality were the outcomes compared between children with and without risk for PARDS. The at-risk criteria, within 48 h of admission, showed an overall accuracy, sensitivity, and specificity of 82.5%, 100%, and 81.9% respectively, to detect patients that progress to PARDS. The at-risk for PARDS criteria was met in 37 cases (20.9%), which also were more likely to developed PARDS (6/37 [16.2%] vs. 0/140 [0%]; p < 0.001), had higher admission to PICU (16/37 [43.2%] vs. 0 [0%]; p < 0.001) and hospital LOS (7 [6; 12] days vs. 5 [3-6] days; p < 0.001), compared with the group without at-risk for PARDS.

The at-risk for PARDS criteria within 48 h of admission demonstrated an adequate ability to identify patients with a respiratory infection at increased risk of developing PARDS. Patients who met the at-risk for PARDS criteria before PICU admission presented with unfavorable clinical outcomes compared with those without risk.