Assistant Professor Ann and Robert H Lurie Children's Hospital of Chicago Ann and Robert H Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Background: Minimal data are available to describe the full severity spectrum among children diagnosed with CAP.
Objective: Toassess the prevalence of clinical outcomes across the severity spectrum for children with CAP across 41 children’s hospitals.
Design/Methods: We performed a multicenter cross-sectional study using data in the Pediatric Health Information System database, including unique ED patients 3 months to 18 years with a primary diagnosis of CAP between January 1, 2016 to March 31, 2020. Initial analyses excluded children with complex chronic conditions (CCC). We evaluated prevalence of outcomes using a 3-tiered composite severity outcome (Table 1) and performed sensitivity analyses to evaluate outcomes in children with CCC, and severity when including children with any associated diagnosis of CAP.
Results: 125,180 children were included (Table 2), of which 86,847 patients (69.4%) were classified as mild, 34,008 (21.2%) as moderate, and 4,325 (3.5%) as severe. Among patients with mild disease, 5.6% were admitted for <2 days and did not require supplemental oxygen. Among children with moderate CAP, hospitalization for >2 days was the only defining criteria in 57.8% (Table 3). Few children with moderate disease who required oxygen had a length of stay <2 days. Among severe patients, positive-pressure ventilation was the largest driving factor (exclusively present in 39.8%). Among children with CCC (n=20,451 unique encounters), more (4,804, 23.5%) had severe outcomes; with fewer in the mild and moderate subgroups (4,236 [20.7%] mild; 11,411 [55.8%] moderate). This group had higher requirement for positive pressure ventilation (18.5%) and ICU admission for ≥3 days (13.0%), and 0.5% died. Out of 162,560 included patients with any diagnosis of CAP, 101,803 (62.6%), 48,656 (29.6%), and 12,101 (7.4%) patients had mild, moderate, and severe CAP, respectively. Conclusion(s): Most (70%) children without CCCs presenting to the ED with CAP have mild disease and can be cared for in the community. Most (57.8%) children classified as moderate severity did not receive major interventions, suggesting that many may not have required admission. Severe disease is rare (<5%). In contrast, a quarter of patients CCC had severe outcomes, underscoring the need for increased attention to this population. As most children with CAP are hospitalized without need for significant intervention, improved tools are needed to minimize unnecessary hospitalizations, in addition to considering how CCC drive disease severity.
Table 1. Application of the composite pneumonia severity measure to PHIS
Table 2. Demographics and clinical characteristics of study cohort overall and by severity type
Table 3. Results by specific criteria in children without CCC (N=125,180)
Table 4. Results by specific criteria for patients with CCC (n=20,451)
Authors/Institutions: Sriram Ramgopal, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Lilliam Ambroggio, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States; Nidhya Navanandran, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States; Jillian Cotter, University of Colorado, Denver, Colorado, United States; Todd Florin, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States