Xing Yan, Wang Dan, Sheng Kai, Xiao Xiumei, Wei Hongling, Liu Ling, Zhou Wei, Tong Xiaomei
Department of Pediatrics, Peking University Third Hospital, Beijing, China.
Department of Emergency, Beijing Children's Hospital, Beijing, China.
Transl Pediatr. 2020 Aug;9(4):522-531. doi: 10.21037/tp-20-149.
The epidemiology and economic burden of hospitalized community-acquired pneumonia (CAP) children due to is still poorly understood. This study aimed to investigate the dynamic changes of pneumonia (MPP) in children in a general hospital.
A total of 2011 CAP children aged 1-16 years hospitalized at Peking University Third Hospital from 2017 to 2019 were enrolled by cross-sectional study for the retrospective analysis of the clinical data mainly including seasonal distribution of MPP, hospital stay, severity, complications, use of flexible bronchoscopy, and hospitalization costs. The dynamic changes of CAP and MPP children within 3 consecutive years and the differences between the MPP group and non-MPP groups were compared.
The proportion of CAP children among hospitalized children was 32.4%, 38.5%, and 39.5% in 2017, 2018, and 2019, respectively, showing an upward trend (P<0.05).The prevalence rate of MPP was highest in the third quarter (30.2%) and the fourth quarter (39.2%) and lowest in the second quarter (13.2%) (χ=51.8, P<0.05). Compared with the non-MPP group, the MPP group had significantly higher incidence of severe pneumonia (19.4% . 12.0%, χ=20.99), incidence of complications (16.1% . 6.5%, χ=48.24), proportion of patients undergoing flexible bronchoscopy (38.4% . 9.0%, χ=252.79), and hospitalization costs (all P<0.05), along with significantly longer hospital stay (6 . 4 days, z=-11.131). A dynamic comparison of the clinical characteristics of MPP in 3 years showed that the number of children with MPP increased significantly in preschoolers in 2018 (37.3%) and in school-aged or older children in 2019 (53%) (P<0.05). MPP peaks occurred in August 2018 and November 2019. The total hospitalization costs, examination fees, and non-medication treatment costs increased significantly (the z values were 35.24, 46.79, and 9.64, respectively; P<0.05) year by year among MPP children; there was no significant difference in the medication cost over these 3 years (z=4.81, P>0.05).
The proportions of severe pneumonia, complications, and use of flexible bronchoscopy as well as the hospitalization days and costs are higher in MPP children. General hospitals should develop integrated clinical quality control programs for MPP children, so as to optimize the allocation of medical resources.
儿童社区获得性肺炎（CAP）的流行病学和经济负担仍未得到充分了解。本研究旨在调查综合医院中儿童支原体肺炎（MPP）的动态变化。
采用横断面研究方法，纳入2017年至2019年在北京大学第三医院住院的1 - 16岁CAP患儿共2011例，对其临床资料进行回顾性分析，主要包括MPP的季节分布、住院时间、严重程度、并发症、纤维支气管镜检查的使用情况及住院费用。比较连续3年CAP和MPP患儿的动态变化以及MPP组与非MPP组之间的差异。
2017年、2018年和2019年住院患儿中CAP患儿的比例分别为32.4%、38.5%和39.5%，呈上升趋势（P<0.05）。MPP患病率在第三季度（30.2%）和第四季度（39.2%）最高，在第二季度（13.2%）最低（χ=51.8，P<0.05）。与非MPP组相比，MPP组重症肺炎发生率（19.4%对12.0%，χ=20.99）、并发症发生率（16.1%对6.5%，χ=48.24）、接受纤维支气管镜检查的患者比例（38.4%对9.0%，χ=252.79）及住院费用（均P<0.05）均显著更高，住院时间也显著更长（6天对4天，z=-11.131）。对3年中MPP临床特征的动态比较显示，2018年学龄前儿童MPP患儿数量显著增加（37.3%），2019年学龄儿童及以上儿童MPP患儿数量显著增加（53%）（P<0.05）。MPP高峰分别出现在2018年8月和2019年11月。MPP患儿的总住院费用、检查费用和非药物治疗费用逐年显著增加（z值分别为35.24、46.79和9.64；P<0.05）；这3年药物费用无显著差异（z=4.81，P>0.05）。
MPP患儿的重症肺炎、并发症、纤维支气管镜检查的使用比例以及住院天数和费用更高。综合医院应制定针对MPP患儿的综合临床质量控制方案，以优化医疗资源配置。
