Department of Pediatrics, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand.
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
PLoS One. 2022 Aug 29;17(8):e0273842. doi: 10.1371/journal.pone.0273842. eCollection 2022.
Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation.
This was a retrospective cohort study done by chart review of all children aged 0-15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort.
The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491-0.602) in the low-risk category, 1.563 (95% CI: 1.454-1.679) in the moderate, and 4.339 (95% CI: 2.527-7.449) in the high-risk.
This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.
由于 COVID-19 患儿可能出现无症状肺炎，导致过度暴露于辐射下，且在资源有限的环境中存在问题，因此我们开展了一项全国性、多中心研究，以确定 COVID-19 患儿肺炎的危险因素，从而制定出小儿肺炎预测评分，并进行评分验证。
这是一项回顾性队列研究，通过对研究期间泰国 13 家医疗中心收治的所有 0-15 岁儿童的病历进行回顾性分析。使用单因素和多因素分析以及向后和向前逐步逻辑回归来生成肺炎评分的最终预测模型。使用前德尔塔时代的数据来创建预测模型，而使用德尔塔时代的数据作为验证队列。
评分开发队列包括前德尔塔时代的 1076 例患者，验证队列包括德尔塔时代的 2856 例患者。经过向后和向前逐步逻辑回归，有 4 个预测因子仍然存在：年龄<5 岁、合并症数量、发热和呼吸困难症状。新型肺炎评分的预测能力可接受，接受者操作特征曲线下面积为 0.677，拟合优度检验良好（p=0.098）。低危组肺炎的阳性似然比为 0.544（95%置信区间：0.491-0.602），中危组为 1.563（95%置信区间：1.454-1.679），高危组为 4.339（95%置信区间：2.527-7.449）。
本研究创建了一个可接受的临床预测模型，可帮助临床医生对 COVID-19 患儿进行适当分诊。
