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.
Insights
Pleural effusion, pleural peel, and thrombocytopenia predict surgical intervention in pediatric pneumonia. Early identification aids timely management for severe cases, improving outcomes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Complicated community-acquired pneumonia (CCAP) in children can lead to severe complications like pleural effusion and empyema, often necessitating surgery.
- Predicting surgical intervention is crucial for timely management of pediatric pneumonia.
- This study included both uncomplicated and complicated pneumonia cases to reflect real-world scenarios.
Purpose of the Study:
- To identify clinical, laboratory, and imaging predictors of surgical management in hospitalized pediatric pneumonia cases.
- To enhance early detection of severe pneumonia requiring surgical intervention.
- To inform clinical decision-making for pediatric pneumonia treatment.
Main Methods:
- A cross-sectional study involving 500 pediatric patients hospitalized with pneumonia.
- Patients were divided into surgical (n=250) and medical (n=250) management groups.
- Logistic regression analysis was used to identify predictors of surgical intervention.
Main Results:
- Pleural effusion (OR=11.679) and pleural peel (OR=15.148) were strong predictors of surgical intervention.
- Thrombocytopenia (OR=0.987) also significantly predicted the need for surgery.
- Elevated inflammatory markers (ESR, CRP) and a history of COVID-19 (protective effect, OR=0.153) were associated with surgical management.
Conclusions:
- Pleural effusion, pleural peel, and thrombocytopenia are key early predictors of surgical intervention in pediatric pneumonia.
- Comprehensive assessment of hospitalized pneumonia cases aids in identifying prognostic factors before overt complications.
- Timely surgical management guided by these predictors is essential for severe pediatric pneumonia cases.
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.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...