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Admission chest radiographs predict illness severity for children hospitalized with pneumonia
Author(s) -
McClain Lauren,
Hall Matthew,
Shah Samir S.,
Tieder Joel S.,
Myers Angela L.,
Auger Katherine,
Statile Angela M.,
Jerardi Karen,
Ann Queen Mary,
Fieldston Evan,
Williams Derek J.
Publication year - 2014
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2227
Subject(s) - medicine , mechanical ventilation , pleural effusion , odds ratio , pneumonia , confounding , intensive care , retrospective cohort study , confidence interval , radiography , lobar pneumonia , propensity score matching , pediatrics , surgery , intensive care medicine
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. Journal of Hospital Medicine 2014;9:559–564. © 2014 Society of Hospital Medicine