Admission chest radiographs predict illness severity for children hospitalized with pneumonia.

TitleAdmission chest radiographs predict illness severity for children hospitalized with pneumonia.
Publication TypeJournal Article
Year of Publication2014
AuthorsMcClain L, Hall M, Shah SS, Tieder JS, Myers AL, Auger KA, Statile AM, Jerardi K, Queen MAnn, Fieldston ES, Williams DJ
JournalJ Hosp Med
Volume9
Issue9
Pagination559-64
Date Published2014 Sep
ISSN1553-5606
KeywordsChild, Child, Preschool, Critical Care, Female, Hospitalization, Humans, Infant, Length of Stay, Male, Patient Admission, Pneumonia, Respiration, Artificial, Retrospective Studies, Severity of Illness Index
Abstract

OBJECTIVE: To assess whether radiographic findings predict outcomes among children hospitalized with pneumonia.

METHODS: This retrospective study included children <18 years of age from 4 children's hospitals admitted in 2010 with clinical and radiographic evidence of pneumonia. Admission radiographs were categorized as single lobar, unilateral or bilateral multilobar, or interstitial. Pleural effusions were classified as absent, small, or moderate/large. Propensity scoring was used to adjust for potential confounders, including need for supplemental oxygen, intensive care, and mechanical ventilation, as well as hospital length of stay and duration of supplemental oxygen.

RESULTS: There were 406 children (median age, 3 years). Infiltrate patterns included: single lobar, 61%; multilobar unilateral, 13%; multilobar bilateral, 16%; and interstitial, 10%. Pleural effusion was present in 21%. Overall, 63% required supplemental oxygen (median duration, 31.5 hours), 8% required intensive care, and 3% required mechanical ventilation. Median length of stay was 51.5 hours. Compared with single lobar infiltrate, all other infiltrate patterns were associated with need for intensive care; only bilateral multilobar infiltrate was associated with need for mechanical ventilation (adjusted odds ratio [aOR]: 3.0, 95% confidence interval [CI]: 1.2-7.9). Presence of effusion was associated with increased length of stay and duration of supplemental oxygen; only moderate/large effusion was associated with need for intensive care (aOR: 3.2, 95% CI: 1.1-8.9) and mechanical ventilation (aOR: 14.8, 95% CI: 9.8-22.4).

CONCLUSIONS: Admission radiographic findings are associated with important hospital outcomes and care processes and may help predict disease severity.

DOI10.1002/jhm.2227
Alternate JournalJ Hosp Med
PubMed ID24942619
PubMed Central IDPMC4154996
Grant ListK23 AI104779 / AI / NIAID NIH HHS / United States
K23AI104779 / AI / NIAID NIH HHS / United States