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Paediatric pneumonia: deriving a model to identify severe disease
  1. Stuart Haggie1,
  2. Elizabeth H Barnes2,
  3. Hiran Selvadurai3,
  4. Hasantha Gunasekera4,
  5. Dominic A Fitzgerald3
  1. 1The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2NHMRC Clinical Trials Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  3. 3Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
  4. 4Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Stuart Haggie, The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; stuart.haggie{at}gmail.com

Abstract

Background Community-acquired pneumonia (CAP) is a leading cause of childhood hospitalisation. Limited data exist on factors predicting severe disease with no paediatric-specific predictive tools.

Methods Retrospective cohort (2011–2016) of hospitalised CAP cases. We analysed clinical variables collected at hospital presentation against outcomes. Stratified outcomes were mild (hospitalised), moderate (invasive drainage procedure, intensive care) or severe (mechanical ventilation, vasopressors, death).

Results We report 3330 CAP cases, median age 2.0 years (IQR 1–5 years), with 2950 (88.5%) mild, 305 (9.2%) moderate and 75 (2.3%) severe outcomes. Moderate-severe outcomes were associated with hypoxia (SaO2 <90%; OR 6.6, 95% CI 5.1 to 8.5), increased work of breathing (severe vs normal OR 5.8, 95% CI 4.2 to 8.0), comorbidities (4+ comorbidities vs nil; OR 8.8, 95% CI 5.5 to 14) and being indigenous (OR 4.7, 95% CI 2.6 to 8.4). Febrile children were less likely than afebrile children to have moderate-severe outcomes (OR 0.57 95% CI 0.44 to 0.74). The full model receiver operating characteristic (ROC) area under the curve (AUC) was 0.78. Sensitivity analyses showed similar results with clinical or radiological CAP definitions. We derived a clinical tool to stratify low, intermediate or high likelihood of severe disease (AUC 0.72). High scores (≥5) had nearly eight times higher odds of moderate-severe disease than those with a low (≤1) score (OR 7.7 95% CI 5.6 to 10.5).

Conclusions A clinical risk prediction tool is needed for child CAP. We have identified risk factors and derived a simple clinical tool using clinical variables at hospital presentation to determine a child’s risk of invasive or intensive care treatment with an ROC AUC comparable with adult pneumonia tools.

  • intensive care units
  • paediatric
  • respiratory medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @stuarthaggie

  • Contributors SH conceptualised, designed the study, collected the data, carried out the initial analyses with EHB, drafted the initial manuscript and revised the manuscript and is responisible for the overall content. HS, HG and DAF assisted in data analysis and critically reviewed and revised the manuscript. Ms Barnes performed the statistical analysis and revised the Methods and Results sections. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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