Related Experiment Video
Updated: Jun 10, 2026
Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Acute Respiratory Tract Infections and Severe Disease Among Hospitalized Children
Haifa Mtaweh1,2,3,4, Caitlyn L Kaziev2, Carlee A Feinstein2
1Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Hospitalized children with viral respiratory tract infections (RTIs) often have chronic conditions. Comorbidities and transfers increase the risk of severe outcomes in pediatric patients with acute RTIs.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- Viral respiratory tract infections (RTIs) epidemiology in children is dynamic, influenced by transmission, seasonality, immunity, and major events like pandemics.
- Understanding these changes is crucial for managing pediatric respiratory illnesses.
Purpose of the Study:
- To describe clinical characteristics and outcomes of children hospitalized with acute RTIs.
- To identify factors associated with an increased risk of severe disease in this pediatric population.
Main Methods:
- A retrospective cohort study involving 2585 children (0-18 years) hospitalized with acute RTIs across two Canadian children's hospitals.
- Data collected included demographics, clinical factors, viral testing results, management, and outcomes, with severe disease defined by critical interventions or death.
- Multivariable robust Poisson regression analyzed risk factors for severe outcomes.
Main Results:
- Respiratory syncytial virus and enterovirus-rhinovirus were the most common viral pathogens identified.
- Over 21% of hospitalized children developed severe disease, with higher risks observed in those with multiple comorbidities or transfer from referring institutions.
- Children with 2+ comorbidities had an adjusted risk ratio (aRR) of 1.62 for severe disease, while transferred patients had an aRR of 4.73.
Conclusions:
- Hospitalized children with acute RTIs frequently present with underlying chronic conditions and necessitate intensive care.
- Factors such as multiple comorbidities and inter-facility transfer significantly elevate the risk of severe disease.
- Insights into the epidemiologic profile and risk factors can guide resource allocation to improve outcomes for pediatric patients with RTIs.
Importance:
The epidemiology of viral respiratory tract infections (RTIs) in children is constantly changing on the basis of transmission, seasonality, immunity, and disruptive events, such as pandemics.
Objective:
To describe the clinical characteristics and outcomes of children hospitalized with acute RTIs and to examine factors associated with risk of severe disease.
Design, Setting, And Participants:
This multisite, retrospective cohort study was conducted at 2 Canadian children's hospitals. Participants included children aged 0 to 18 years who were hospitalized with acute RTIs from July 1, 2022, to June 30, 2023. Follow-up for readmission was performed at 30 days after discharge. Analysis was conducted in June to November 2025.
Exposure:
Clinical and demographic factors, signs and symptoms, diagnostic testing, viral testing, management, and interventions.
Main Outcomes And Measures:
The primary outcome was the proportion of patients who developed severe disease, defined as the need for noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation therapy, or kidney replacement therapy; cardiac arrest; or death. Demographics and clinical characteristics were also described. Multivariable robust Poisson regression was used to evaluate factors associated with risk of severe outcomes and was reported as adjusted risk ratios (aRRs) with 95% CIs.
Results:
There were 2585 children hospitalized with acute RTIs, with a median (IQR) age of 2.5 (0.9-5.0) years. There were 1542 male children (59.7%), and 1307 patients (50.6%) had at least 1 chronic condition, with neurologic, developmental, or genetic conditions being the most common. More than one-third (879 children [34.0%]) were transferred from a referring institution. Viral testing was performed for 2332 patients (90.2%), with a viral pathogen identified in 1828 (70.7%) of those tested. Viral coinfections were detected in 338 children. The most common viruses were respiratory syncytial virus (709 children) and enterovirus-rhinovirus (598 children). The median (IQR) length of hospital stay was 3 (2-6) days. Nearly one-quarter of children (551 children [21.3%]) developed severe disease. Those with 2 or more comorbidities (aRR, 1.62; 95% CI, 1.36-1.93) or who were transferred from a referring hospital (aRR, 4.73; 95% CI, 4.01-5.59) were at increased risk of severe disease.
Conclusions And Relevance:
This cohort study found that hospitalized children with acute RTIs frequently have underlying chronic conditions and often require intensive intervention. Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients.
Related Concept Videos
01:29Microbiota of the Respiratory Tract
01:29Respiratory Syncytial Virus Disease
01:29Pneumonia I: Introduction
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...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
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: