Florin Todd Adam, Tancredi Daniel Joseph, Ambroggio Lilliam, Babl Franz E, Dalziel Stuart R, Eckerle Michelle, Mintegi Santiago, Neuman Mark, Plint Amy C, Kuppermann Nathan
Department of Pediatrics, Division of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
Department of Pediatrics, UC Davis School of Medicine, Sacramento, California, USA.
BMJ Open. 2020 Dec 2;10(12):e041093. doi: 10.1136/bmjopen-2020-041093.
INTRODUCTION: Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs. METHODS AND ANALYSIS: This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7-14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models. ETHICS AND DISSEMINATION: This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children's Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.
引言:肺炎是儿童急诊科就诊和住院的常见且费用高昂的原因。目前尚无基于证据且经过验证的工具来协助医生对因社区获得性肺炎(CAP)就诊于急诊科的儿童进行管理和处置决策。本研究的目的是开发一种临床预测模型,以准确地对全球急诊科网络中患有CAP且有低、中、重度疾病风险的儿童进行分层。 方法与分析:本研究是一项前瞻性队列研究,在儿科急诊研究网络(PERN;https://pern-global.com/)约80个成员机构的急诊科招募多达4700名患有CAP的儿童。我们将纳入临床诊断为CAP的3个月至<14岁儿童。我们将排除在研究就诊前7天内有住院史、医院获得性肺炎或慢性复杂疾病的儿童。将收集急诊科就诊时以及7天内住院期间的临床、实验室和影像学数据。就诊后7 - 14天将完成随访电话或短信调查。主要结局是疾病严重程度的三级综合指标。将使用假设部分比例优势规范的有序逻辑回归和递归划分来开发风险分层模型。 伦理与传播:本研究将产生一种临床预测模型,以准确识别就诊于急诊科时的重症疾病风险。研究纳入的所有机构均已获得伦理批准。辛辛那提儿童医院机构审查委员会(IRB)作为美国大多数机构的中央IRB。将获得所有参与者的知情同意。研究结果将通过国际会议和同行评审出版物进行传播。本研究克服了先前肺炎严重程度评分的局限性,通过使研究结果具有广泛的普遍性,在模型开发和验证后可积极应用。
Hosp Pediatr. 2018-11
Hosp Pediatr. 2024-2-1
Pediatr Emerg Care. 2021-7-1
Pediatrics. 2020-5-13
Pediatr Emerg Care. 2021-12-1
Pediatr Infect Dis J. 2019-9
J Pediatric Infect Dis Soc. 2018-12-3
Pediatrics. 2016-10
Clin Respir J. 2018-1
J Allergy Clin Immunol Pract. 2015
Pediatr Pulmonol. 2015-7
Pediatr Infect Dis J. 2013-3