| dc.identifier.citation | Berg, A. S., Inchley, C. S., Fjaerli, H. O., Leegaard, T. M., & Nakstad, B. (2017). Assessing Severity in Pediatric Pneumonia: Predictors of the Need for Major Medical Interventions. Pediatric emergency care. | en |
| dc.description.abstract | Objective: The aim of this study was to determine potential predictors of
the need for major medical interventions in the context of assessing severity
in pediatric pneumonia.
Methods: This was a prospective, cohort study of previously healthy
children and adolescents younger than 18 years presenting to the pediatric
emergency room with clinically suspected pneumonia and examining both
the full cohort and those with radiologically confirmed pneumonia. The
presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific
tachypnea, high temperature (≥38.5°C), chest retraction score, modified
Pediatric Early Warning Score, age, C-reactive protein, white blood cell
(WBC) count, and chest radiograph findings at first assessment were analyzed
by univariate and multivariate analyses to examine their predictive
ability for the need for major medical interventions: supplemental oxygen,
supplemental fluid, respiratory support, intensive care, or treatment for
complications during admission.
Results: Fifty percent of the 394 cases of suspected pneumonia and 60%
of the 265 cases of proven pneumonia were in need of 1 or more medical
interventions. In multivariate logistic regression, only the presence of
hypoxemia (odds ratios, 3.66 and 3.83 in suspected and proven pneumonia,
respectively) and chest retraction score (odds ratios, 1.21 and
1.31, respectively for each 1-point increase in the score) significantly
predicted the need for major medical interventions in both suspected
and proven pneumonia. Specificity of 94% or greater, positive likelihood
ratio of 6.4 or greater, and sensitivity of less than 40% were found
for both hypoxemia and chest retraction score in predicting major medical
interventions. C-reactive protein and white blood cell count were
not associated with the need for these interventions, whereas multifocal
radiographic changes were.
Conclusions: Hypoxemia and an assessment of chest retractions were
the predictors significantly able to rule in more severe pneumonia, but with
a limited clinical utility given their poor ability to rule out the need for
major medical interventions. Future validation of these findings is needed.
Key Words: pneumonia, sensitivity and specificity, severity predictors
(Pediatr Emer Care 2017;00: 00–00) | en |
