Open AccessNomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study
Author(s) -
Tsu Jen Kuo,
Chiao-Lin Hsu,
PeiHsun Liao,
Shih-Ju Huang,
Yao-Min Hung,
Chun-Hao Yin
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0235069
Subject(s) - nomogram , medicine , pneumonia , pediatrics , population , logistic regression , cerebral palsy , asthma , retrospective cohort study , cohort , cohort study , physical therapy , environmental health
Background Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. Methods This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1 st , 1997 and December 31 st , 2013 and followed them up through December 31 st , 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. Results Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. Conclusions The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.