Ghosh Arindam, Annigeri Saba, Hemram Sunil Kumar, Dey Pranab Kumar, Mazumder Sangita
Department of Paediatrics, Midnapore Medical College and Hospital, Midnapore, West Bengal, India.
Department of Paediatrics, RG Kar Medical College and Hospital, Kolkata, West Bengal, India.
Indian J Crit Care Med. 2022 Nov;26(11):1210-1217. doi: 10.5005/jp-journals-10071-24350.
The objective was to delineate the clinico-epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRI) during its recent outbreak and to find out the independent predictors of pediatric intensive care unit (PICU) admission.
Children aged between 1 month and 12 years who tested positive for RSV were included. Multivariate analysis was performed to identify the independent predictors and predictive scores were developed from the β-coefficients. Receiver operating characteristic curve (ROC) was generated and the area under the curve (AUC) was calculated to assess the overall precision. The performance of sum scores in predicting PICU need, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR and LR) were calculated for each cutoff value.
The proportion of RSV positivity was 72.58%. A total of 127 children were included with a median [interquartile range (IQR)] age of 6 (2-12) months, of whom 61.42% were males and 33.07% had underlying comorbidity. Tachypnea, cough, rhinorrhea, and fever were predominant clinical presentations while hypoxia and extrapulmonary manifestations were present in 30.71% and 14.96% of children, respectively. About 30% required PICU admission, and 24.41% developed complications. Premature birth, age below 1 year, presence of underlying CHD, and hypoxia were independent predictors. The AUC [95% confidence interval (CI)] was 0.869 (0.843-0.935). Sum score below 4 had 97.3% sensitivity and 97.1% NPV whereas sum score above 6 had 98.9% specificity, 89.7% PPV, 81.3% NPV, 46.2 LR, and 0.83 LR to predict PICU needs.
Awareness of these independent predictors and application of the novel scoring system will be beneficial for busy clinicians in planning the level of care needed, thereby optimizing PICU resource utilization.
Ghosh A, Annigeri S, Hemram SK, Dey PK, Mazumder S. Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective. Indian J Crit Care Med 2022;26(11):1210-1217.
目的是描述近期呼吸道合胞病毒（RSV）相关急性下呼吸道感染（RSV-ALRI）住院儿童的临床流行病学特征，并找出儿科重症监护病房（PICU）收治的独立预测因素。
纳入RSV检测呈阳性的1个月至12岁儿童。进行多变量分析以确定独立预测因素，并根据β系数制定预测分数。生成受试者工作特征曲线（ROC）并计算曲线下面积（AUC）以评估总体精度。针对每个临界值计算总分在预测PICU需求方面的表现、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）以及阳性和阴性似然比（LR+和LR-）。
RSV阳性率为72.58%。共纳入127名儿童，中位年龄[四分位间距（IQR）]为6（2-12）个月，其中61.42%为男性，33.07%有基础疾病。呼吸急促、咳嗽、流涕和发热是主要临床表现，分别有30.71%和14.96%的儿童出现缺氧和肺外表现。约30%的儿童需要入住PICU，24.41%出现并发症。早产、1岁以下、存在基础先天性心脏病（CHD）和缺氧是独立预测因素。AUC[95%置信区间（CI）]为0.869（0.843-0.935）。总分低于4时，敏感性为
