Clinical decision-making in pediatric pneumonia: when to consider interventional: procedures? A retrospective
Sarah Khosropanah1, Hamid Kermanshahi2, Leila Ameri3
1School of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran.
Background:
Complicated community-acquired pneumonia (CCAP) in children often leads to severe complications such as pleural effusion and empyema, which may require surgical intervention. This study aimed to identify clinical, laboratory, and imaging predictors of surgical management among hospitalized pediatric pneumonia cases, including both uncomplicated and complicated presentations, to reflect the real-world clinical scenario.
Methods:
We conducted a cross-sectional study over 3 years (May 2020-May 2023) including 500 pediatric patients hospitalized with pneumonia. The cohort included both uncomplicated and complicated cases to capture predictors of progression to surgical intervention. Patients were categorized into those requiring surgery (n = 250) and those managed medically (n = 250). Clinical, laboratory, and imaging data were collected and analyzed using logistic regression to identify predictors of surgical intervention.
Results:
Key factors associated with surgical intervention included the presence of pleural effusion (odds ratio [OR] = 11.679, P < 0.001) and pleural peel (OR = 15.148, P < 0.001). Thrombocytopenia was also identified as a significant predictor (OR = 0.987, P = 0.005). Elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, were more prevalent in the surgical group, as was a history of COVID-19, which showed a protective effect (OR = 0.153, P < 0.001). No significant association was found between leukocytosis or influenza history and the need for surgical management.
Conclusions:
Pleural effusion, pleural peel, and thrombocytopenia are key early predictors of surgical intervention in pediatric pneumonia, especially in cases progressing to CCAP. Including the full spectrum of hospitalized pneumonia cases allows for identification of prognostic factors before complications become clinically overt. These findings emphasize the importance of comprehensive assessment to guide timely surgical management. Further multicenter studies are needed to validate these predictors and improve early identification of severe pediatric pneumonia.
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