Department of Pediatrics (Infectious Diseases, Hospital Medicine and Epidemiology), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States of America.
Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, United States of America.
PLoS One. 2022 Aug 12;17(8):e0272029. doi: 10.1371/journal.pone.0272029. eCollection 2022.
Decisions regarding the evaluation of children with influenza infection rely on the likelihood of severe disease. The role of early vital signs as predictors of severe influenza infection in children is not well known. Our objectives were to determine the value of vital signs in predicting hospitalization/recurrent emergency department (ED) visits due to influenza infection in children.
We conducted a prospective study of children aged 6 months to 8 years of age with influenza like illness evaluated at an ED/UC from 2016-2018. All children underwent influenza testing by PCR. We collected heart rate, respiratory rate and temperature, and converted heart rate (HR) and respiratory rate (RR) to z-scores by age. HR z scores were further adjusted for temperature. Our primary outcome was hospitalization/recurrent ED visits within 72 hours. Vital sign predictors with p< 0.2 and other clinical covariates were entered into a multivariable logistic regression model to determine odds ratios (OR) and 95% CI; model performance was assessed using the Brier score and discriminative ability with the C statistic.
Among 1478 children, 411 (27.8%) were positive for influenza, of which 42 (10.2%) were hospitalized or had a recurrent ED visit. In multivariable analyses, adjusting for age, high-risk medical condition and school/daycare attendance, higher adjusted respiratory rate (OR 2.09, 95%CI 1.21-3.61, p = 0.0085) was a significant predictor of influenza hospitalization/recurrent ED visits.
Higher respiratory rate adjusted for age was the most useful vital sign predictor of severity among young children with PCR-confirmed influenza.
评估流感感染儿童的决策依赖于严重疾病的可能性。早期生命体征作为儿童严重流感感染预测指标的作用尚不清楚。我们的目的是确定生命体征在预测儿童流感感染导致住院/再次急诊科（ED）就诊的价值。
我们进行了一项前瞻性研究，纳入了 2016 年至 2018 年在急诊科/UC 就诊的年龄在 6 个月至 8 岁的流感样疾病患儿。所有患儿均接受了聚合酶链反应（PCR）流感检测。我们收集了心率、呼吸频率和体温，并通过年龄将心率（HR）和呼吸频率（RR）转换为 z 分数。HR z 分数进一步根据体温进行调整。我们的主要结局是在 72 小时内住院/再次 ED 就诊。将 p 值<0.2 的生命体征预测因子和其他临床协变量纳入多变量逻辑回归模型，以确定优势比（OR）和 95%置信区间（CI）；使用 Brier 评分和 C 统计量评估模型性能来评估判别能力。
在 1478 名儿童中，411 名（27.8%）流感检测呈阳性，其中 42 名（10.2%）住院或再次 ED 就诊。在多变量分析中，调整年龄、高危医疗状况和上学/日托出勤率后，较高的调整呼吸频率（OR 2.09，95%CI 1.21-3.61，p=0.0085）是流感住院/再次 ED 就诊的显著预测因子。
调整年龄后的较高呼吸率是 PCR 确诊流感的幼儿严重程度的最有用的生命体征预测指标。
