RT Journal Article
SR Electronic
T1 Paediatric pneumonia: deriving a model to identify severe disease
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP archdischild-2021-322665
DO 10.1136/archdischild-2021-322665
A1 Stuart Haggie
A1 Elizabeth H Barnes
A1 Hiran Selvadurai
A1 Hasantha Gunasekera
A1 Dominic A Fitzgerald
YR 2021
UL http://adc.bmj.com/content/early/2021/11/10/archdischild-2021-322665.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.