Bender Jeffrey M, Ampofo Krow, Gesteland Per, Stoddard Gregory J, Nelson Douglas, Byington Carrie L, Pavia Andrew T, Srivastava Rajendu
Department of Pediatrics, Division of Pediatric Infectious Disease, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
Pediatr Emerg Care. 2009 Jun;25(6):369-75. doi: 10.1097/PEC.0b013e3181a792a9.
Influenza virus infections cause significant morbidity and often result in hospitalization in children. Many children with influenza seek care in emergency settings during seasonal influenza epidemics. We hypothesized that certain features could predict the need for hospitalization in children with influenza.
Retrospective cohort study of all children 18 years or younger seen at a children's hospital with laboratory-confirmed influenza infection between July 2001 and June 2004. Medical records of children with confirmed influenza virus infection were reviewed. Predictors of admission were identified using logistic regression models. An influenza risk score system was created and validated based on 4 predictors.
We identified 1230 children with laboratory proven influenza virus infection, 541 were hospitalized. Multivariate logistic regression demonstrated that 4 predictors were independently strongly associated with hospitalization. In the clinical prediction rule for children with influenza who were hospitalized, history of a high-risk medical condition (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.91-5.68) was worth 2 points. Respiratory distress on physical examination (OR, 2.33; 95% CI, 1.61-3.38) was worth 1 point. Radiographic evidence of focal pneumonia (OR, 7.82; 95% CI, 3.62-16.92) was worth 3 points and influenza B infection (OR, 3.99; 95% CI, 2.57-6.21) was worth 2 points. High-risk children with influenza with a total risk score of 3 to 8 had an 86% probability of hospitalization.
The presence of a high-risk medical condition, respiratory distress on physical examination, radiographic evidence of focal pneumonia, and influenza B infection were the 4 strongest predictors of hospitalization. The risk score assigned to a child with influenza may provide a disposition tool for predicting hospitalization in children in seasonal influenza epidemics.
流感病毒感染会导致儿童出现严重发病情况，并常常致使其住院治疗。许多患流感的儿童在季节性流感流行期间会前往急诊部门就医。我们推测某些特征可预测流感患儿的住院需求。
对2001年7月至2004年6月期间在一家儿童医院就诊且实验室确诊为流感感染的所有18岁及以下儿童进行回顾性队列研究。对确诊为流感病毒感染的儿童的病历进行了审查。使用逻辑回归模型确定入院的预测因素。基于4个预测因素创建并验证了一个流感风险评分系统。
我们确定了1230例经实验室证实为流感病毒感染的儿童，其中541例住院治疗。多因素逻辑回归表明，4个预测因素与住院治疗独立且密切相关。在流感住院患儿的临床预测规则中，高危疾病史（比值比[OR]，4.06；95%置信区间[CI]，2.91 - 5.68）计2分。体格检查时有呼吸窘迫（OR，2.33；95%CI，1.61 - 3.38）计1分。局灶性肺炎的影像学证据（OR，7.82；95%CI，3.62 - 16.92）计3分，乙型流感感染（OR，3.99；95%CI，2.57 - 6.21）计2分。总风险评分为3至8分的高危流感患儿住院概率为86%。
高危疾病史、体格检查时的呼吸窘迫、局灶性肺炎的影像学证据以及乙型流感感染是住院治疗的4个最强预测因素。分配给流感患儿的风险评分可为预测季节性流感流行期间儿童住院情况提供一种处置工具。
