Characterization of Children Younger than 5 Years of Age with Severe Community-Acquired Alveolar Pneumonia (CAAP) Requiring Pediatric Intensive Care Unit (PICU) Admission

Feinstein, Yael; Greenberg, David; Ben-Shimol, Shalom; Mimran, Maya; Dagan, Ron; Givon-Lavi, Noga

Abstract Background The purpose of this study was to determine factors characterizing children admitted to the Pediatric Intensive Care Unit (PICU) with community-acquired alveolar pneumonia (CAAP) to help clinicians assess disease severity upon initial assessment in the emergency department. Methods We prospectively collected demographic, clinical, and laboratory data of children <5 years with radiologically confirmed CAAP referred to the Soroka University Medical Center during 2001–2011. Three groups of children were compared: 1) those hospitalized in the PICU (PICU-CAAP); 2) those treated in the emergency department and discharged (ED-CAAP); and 3) those hospitalized in a pediatric ward (Hosp-CAAP). Results Of 9,722 CAAP episodes, 367 (3.8%) were PICU-CAAP, 5,552 (57.1%) Hosp-CAAP and 3,803 (39.1%) ED-CAAP. In a univariate analysis, respiratory syncytial virus (RSV) was detected more commonly among PICU-CAAP than in Hosp-CAAP (P=0.02) and ED-CAAP patients (P<0.001). In a multivariate analysis, several factors were associated with PICU hospitalization versus ED-CAAP and Hosp-CAAP: Younger age (ORs: 1.04, [95%CI: 1.02-1.05] and 0.97 [0.96–0.98], respectively); prematurity (ORs: 2.16 [1.28–3.64] and 1.61 [1.15–2.26], respectively), lower O2 saturation (ORs: 1.32 [1.25-1.41] and 0.94[0.92-0.96]), higher respiratory rate (ORs: 1.06 [1.04-1.07] and 1.00 [1-1.01], respectively). Conclusion Children admitted to PICU were younger, had more respiratory syncytial virus (RSV) detection, were premature, had lower O2 saturation, and had a higher respiratory rate than those admitted to the general ward or those visiting the emergency department and subsequently discharged.