The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, New South Wales, Australia
NHMRC Clinical Trials Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
Arch Dis Child. 2022 May;107(5):491-496. doi: 10.1136/archdischild-2021-322665. Epub 2021 Nov 10.
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.
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).
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 (SaO <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).
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.
社区获得性肺炎（CAP）是导致儿童住院的主要原因。目前尚无儿科专用预测工具，关于预测严重疾病的因素的数据有限。
这是一项回顾性队列研究（2011-2016 年），对住院 CAP 患者的临床变量进行分析，与结局相对照。分层结局为轻度（住院）、中度（有创引流术、重症监护）或重度（机械通气、血管加压药、死亡）。
报告了 3330 例 CAP 病例，中位年龄为 2.0 岁（IQR 1-5 岁），2950 例（88.5%）为轻度，305 例（9.2%）为中度，75 例（2.3%）为重度。中重度结局与低氧血症（SaO <90%；OR 6.6，95%CI 5.1 至 8.5）、呼吸功增加（严重 vs 正常 OR 5.8，95%CI 4.2 至 8.0）、合并症（≥4 种合并症 vs 无；OR 8.8，95%CI 5.5 至 14）和土著人（OR 4.7，95%CI 2.6 至 8.4）有关。发热儿童与不发热儿童相比，中重度结局的可能性较低（OR 0.57，95%CI 0.44 至 0.74）。全模型受试者工作特征（ROC）曲线下面积（AUC）为 0.78。敏感性分析显示，采用临床或影像学 CAP 定义的结果相似。我们得出了一种临床工具，用于分层严重疾病的低、中、高可能性（AUC 0.72）。高评分（≥5）比低评分（≤1）发生中重度疾病的可能性高近 8 倍（OR 7.7，95%CI 5.6 至 10.5）。
需要为儿童 CAP 制定临床风险预测工具。我们已经确定了危险因素，并根据住院时的临床变量得出了一种简单的临床工具，以确定儿童接受有创或重症监护治疗的风险，ROC AUC 与成人肺炎工具相当。
