Can Doctors Predict Which Children with Pneumonia Will Develop Mild or Severe Disease?

Currently, there are no evidence-based rules that help physicians in the Emergency Department (ED) predict if a child with community-acquired pneumonia will have a mild disease course that can be treated at home or a more severe illness that requires hospitalization.

A recent study published in the journal Pediatrics found that the predictive accuracy of clinical judgement was generally fair, but clinicians were least accurate when predicting progression to severe disease in children initially classified as having “low to moderate” risk, which accounts for a large portion of children presenting with pneumonia.

Community-acquired pneumonia is one of the most common infections in children. Although most children with pneumonia fully recover after a mild illness, around 5 percent become severely sick and develop serious complications.

“In our study, physicians relying on clinical judgement to predict the risk of complications from pneumonia performed well, but there is room to improve,” said senior author Todd Florin, MD, MSCE, director of research in emergency medicine at the Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor of pediatrics at Northwestern University Feinberg School of Medicine. “Our study establishes the need for objective, evidence-based tools to augment, and possibly improve upon, individual clinician’s judgement, so that physicians can more accurately identify children that require earlier treatments to prevent development of severe disease.”

Florin is leading efforts to provide one of the first evidence-based, risk-scoring tools for pediatric community-acquired pneumonia, to be used in conjunction with and improve ED physicians’ ability to risk stratify children with this disease. At this stage, he and colleagues developed the tool and validated it at a single center. Their work was published in November 2020.

“Our next step is to externally validate this pediatric tool in a multi-center study before it can be broadly implemented,” said Florin.

Source: Ann and Robert H. Lurie Children's Hospital of Chicago

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