Admission chest radiographs predict illness severity for children hospitalized with pneumonia

Creator(s)

Lauren McClain, Monroe Carell Jr. Children's Hospital at Vanderbilt
Matthew Hall, Children's Hospital Association
Samir S. Shah, University of Cincinnati College of Medicine
Joel S. Tieder, University of Washington School of Medicine
Angela Myers, Children's Mercy HospitalFollow
Katherine Auger, University of Cincinnati College of Medicine
Angela M. Statile, University of Cincinnati College of Medicine
Karen Jerardi, University of Cincinnati College of Medicine
Mary Ann Queen, Children's Mercy HospitalFollow
Evan Fieldston, University of Pennsylvania Perelman School of Medicine
Derek J. Williams, Monroe Carell Jr. Children's Hospital at Vanderbilt

Document Type

Article

Publication Date

9-2014

Identifier

DOI: 10.1002/jhm.2227; PMCID: PMC4154996

Abstract

© 2014 Society of Hospital Medicine.

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

Methods: This retrospective study included children 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.

Journal Title

Journal of Hospital Medicine

Volume

9

Issue

9

First Page

559

Last Page

564

Comments

Grant support

• K23 AI104779/AI/NIAID NIH HHS/United States
• K23AI104779/AI/NIAID NIH HHS/United States

Recommended Citation

McClain, L., Hall, M., Shah, S. S., Tieder, J. S., Myers, A., Auger, K., Statile, A. M., Jerardi, K., Queen, M., Fieldston, E., Williams, D. J. Admission chest radiographs predict illness severity for children hospitalized with pneumonia Journal of Hospital Medicine 9, 559-564 (2014).