Javeed Iqbal Bhat1, Bashir A Charoo2, Aparna Mukherjee3, Ridwana Ahad2, Rashmi R Das4, Jagdish Prasad Goyal5, Bhadresh Vyas6, Vinod H Ratageri7, Rakesh Lodha8. 1. Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir. Correspondence to: Dr Javeed Iqbal Bhat, Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. drjaveediqbal@gmail.com. 2. Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir. 3. Indian Council of Medical Research, New Delhi. 4. Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha. 5. Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan. 6. Department of Pediatrics, MP Saha Medical College, Jamnagar, Gujarat. 7. Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka. 8. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Abstract
OBJECTIVE: To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP). DESIGN: Prospective cohort study. SETTING: Multi-site hospital based study. INTERVENTION: A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2-59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day). MAIN OUTCOME MEASURE: Risk factors for hospitalization among pneumonia patients. RESULTS: A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multi-variate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, P=0.01), procalcitonin level >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95% CI: 0.6, 0.9, P=0.02). CONCLUSION: Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.
OBJECTIVE: To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP). DESIGN: Prospective cohort study. SETTING: Multi-site hospital based study. INTERVENTION: A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2-59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day). MAIN OUTCOME MEASURE: Risk factors for hospitalization among pneumonia patients. RESULTS: A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multi-variate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, P=0.01), procalcitonin level >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95% CI: 0.6, 0.9, P=0.02). CONCLUSION: Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.