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Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia.

ABSTRACT: BACKGROUND:Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits. METHODS:Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models. RESULTS:Of the 3304 index ED visits by patients with CAP, 148 (4.5%) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95% confidence interval: 1.29-3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63% and 49%, respectively) to revisit the ED (95% confidence interval: 0.24-0.56 and 0.30-0.85, respectively). CONCLUSIONS:Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.

SUBMITTER: Ambroggio L

PROVIDER: S-EPMC6309976 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia.

Ambroggio Lilliam L Herman Helena H Fain Emily E Huang Guixia G Florin Todd A TA

Hospital pediatrics 20181101 11

<h4>Background</h4>Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits.<h4>Methods</h4>Children aged 3 months to 18 years with an <i>International Classification of Diseases, Ninth Revision</i> diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The p ...[more]

PMID: 30352815

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Project description:Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed.We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists.From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%).The burden of hospitalization for children with community-acquired pneumonia was highest among the very young, with respiratory viruses the most commonly detected causes of pneumonia. (Funded by the Influenza Division of the National Center for Immunization and Respiratory Diseases.).

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Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia.

Publications

Clinical Risk Factors for Revisits for Children With Community-Acquired Pneumonia.

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