Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia; Department of Paediatrics, Shoalhaven District Memorial Hospital, Nowra 2541, Australia.
Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia; Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2145, Australia.
Paediatr Respir Rev. 2021 Sep;39:71-81. doi: 10.1016/j.prrv.2020.10.004. Epub 2020 Oct 17.
World Health Organisation definitions of pneumonia severity are routinely used in research. In high income health care settings with high rates of pneumococcal vaccination and low rates of mortality, malnutrition and HIV infection, these definitions are less applicable. National guidelines from leading thoracic and infectious disease societies describe 'severe pneumonia' according to criteria derived from expert consensus rather than a robust evidence base. Contemporary cohort studies have used clinical outcomes such as intensive care therapy or invasive procedures for complicated pneumonia, to define severe disease. Describing severe pneumonia in such clinically relevant terms facilitates the identification of risk factors associated with worsened disease and the subsequently increased morbidity, and need for tertiary level care. The early recognition of children at higher risk of severe pneumonia informs site of care decisions, antibiotic treatment decisions as well as guiding appropriate investigations. Younger age, malnutrition, comorbidities, tachypnoea, and hypoxia have been identified as important associations with 'severe pneumonia' by WHO definition. Most studies have been performed in low-middle income countries and whilst they provide some insight into those at risk of mortality or treatment failure, their generalisability to the high-income setting is limited. There is a need to determine more precise definitions and criteria for severe disease in well-resourced settings and to validate factors associated with intensive care admission or invasive procedures to enhance the early recognition of those at risk.
世界卫生组织（WHO）对肺炎严重程度的定义通常用于研究。在高收入的医疗保健环境中，肺炎球菌疫苗接种率高，死亡率、营养不良和艾滋病毒感染率低，这些定义的适用性较低。来自领先的胸科和传染病学会的国家指南根据专家共识而不是基于稳健证据的标准来描述“严重肺炎”。当代队列研究使用临床结果，如重症肺炎的强化治疗或有创治疗，来定义严重疾病。以如此具有临床意义的术语来描述严重肺炎有助于确定与疾病恶化相关的危险因素，以及随后增加的发病率和对三级护理的需求。早期识别患有严重肺炎风险较高的儿童有助于确定护理地点、抗生素治疗决策，并指导进行适当的检查。年龄较小、营养不良、合并症、呼吸急促和缺氧已被 WHO 定义为与“严重肺炎”相关的重要因素。大多数研究都是在中低收入国家进行的，虽然它们提供了一些关于死亡风险或治疗失败风险的信息，但它们在高收入环境中的普遍性有限。需要确定资源充足环境中严重疾病的更精确定义和标准，并验证与重症监护入院或有创治疗相关的因素，以增强对风险人群的早期识别。
